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Efficacy of Apolipoprotein A-1 Infusion on Coronary Atherosclerosis Postacute Coronary Syndrome: A Network
Shree Rath1, Mohamed Saad Sayed2, Fatima Saeed3
1From the Department of Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Insights
Apolipoprotein A-1 (ApoA1) infusion, specifically ETC-216 at 45mg, significantly reduced percent atheroma volume in acute coronary syndrome patients. Further trials are needed to confirm these findings for atherosclerosis treatment.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Imaging
Background:
- High-density lipoproteins (HDL) exhibit beneficial circulatory effects.
- Apolipoprotein A-1 (ApoA1), an HDL mimetic, may slow atherosclerosis progression post-acute coronary syndrome (ACS).
Purpose of the Study:
- To systematically evaluate the efficacy of ApoA1 infusion in reducing atheroma volume in ACS patients.
- To compare different ApoA1 infusion preparations (ETC-216, CER-001, CSL-111, MDCO-216) via network meta-analysis.
Main Methods:
- Systematic search of randomized controlled trials (RCTs) up to May 10, 2024.
- Inclusion of RCTs comparing ApoA1 infusion to placebo within 2 weeks of an ACS event.
- Network meta-analysis of 5 RCTs assessing changes in percent atheroma volume (PAV) and total atheroma volume.
Main Results:
- Only ETC-216 45mg demonstrated a statistically significant reduction in PAV (MD: -12.74).
- Other ApoA1 regimens and total atheroma volume changes showed no significant treatment effects.
- PAV was lowest at follow-up in CER-001 3mg and MDCO-216 20mg groups, but these were not statistically significant.
Conclusions:
- ETC-216 45mg significantly reduced PAV in ACS patients.
- The findings underscore the need for further clinical trials to validate ETC-216 for ACS patient response enhancement.
Abstract:
High-density lipoproteins have various potentially beneficial circulatory effects. Apolipoprotein A-1, one of the high-density lipoproteins mimetics, has been shown in several studies to slow the progression of atherosclerosis after an acute coronary syndrome (ACS) event. We systematically searched articles published up to May 10, 2024. Eligible randomized controlled trials enrolled adults who received ApoA1 infusion, compared to a placebo, within 2 weeks of an ACS event. ApoA1 infusion preparations evaluated include ETC-216, CER-001, CSL-111, and MDCO-216. Network meta-analysis was performed. A total of 5 randomized controlled trials were included in our analysis. For changes in percent atheroma volume (PAV), only ETC-216 45 mg was statistically significant [mean difference (MD): -12.74, (-20.70; -4.78)]. All other regimens were statistically insignificant. In addition, changes in total atheroma volume showed no significant treatment effects. PAV was lowest at follow-up in the CER-001 3 mg [MD, -1.68; (-4.73-1.38)] and MDCO-216 20 mg [MD, 1.00; (-3.64-5.64)] groups; all other ETC-216 and CER-001 regimens were insignificant. Our analysis concludes that ETC-216, 45 mg, showed a significant reduction in PAV. This analysis highlights the need for further clinical trials to explore this regimen for enhancing responses in ACS patients.
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