PCSK9阻害剤のエヴォロキュマブで非常に低いLDLコレステロール濃度を達成する臨床効果と安全性: FOURIER試験の予め指定された二次分析
Robert P Giugliano1, Terje R Pedersen2, Jeong-Gun Park1
1TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Lancet (London, England)
|September 2, 2017
まとめ
エヴォロキュマブで非常に低いLDLコレステロールレベルを達成すると,安全性の懸念なしに心血管疾患のリスクが著しく低下します. これらの発見は,LDLコレステロールを心血管疾患の患者に対する現在のガイドライン以下に低下させることを支持しています.
科学分野:
- 心血管医学
- 薬理学について
- 臨床試験
背景:
- 低密度脂質タンパク質 (LDL) コレステロールは,動脈硬化性心血管疾患の主要な危険因子です.
- LDL コレステロールを減らすための最適で安全な値については,まだ議論の余地があります.
- FOURIER試験では,PCSK9阻害剤であるエボロキュマブが心血管疾患のリスクを軽減することを研究した.
研究 の 目的:
- 4週後のLDLコレステロール値とFOURIER試験における臨床結果の関係を調べる.
- 徐々にLDLコレステロール濃度を下げるための安全性を評価する.
- 心血管疾患の広い患者集団におけるエヴォロキュマブの有効性を評価する.
主な方法:
- ランダム化されたFOURIER試験の患者25,982人を対象とした二次分析.
- 4週間のLDLコレステロールと心血管疾患のアウトカムおよび安全性に関するイベントの関連性を平均2.2年にわたって調べました.
- LDLコレステロールレベルに影響を与えるベースラインの要因を調整するために多変量モデルを使用した.
主要な成果:
- 低LDLコレステロールと初等および二次複合心血管エンドポイントの減少との間に,0. 2mmol/ Lまでの有意な単調な関係が観察されました.
- 重篤な有害事象を含む,達成されたLDLコレステロール値と安全性との間に有意な関連性が見つかりませんでした.
- 患者の10%がLDLコレステロール<0. 5mmol/ Lを達成し,最も低いパーセンチルまで利益が見られた.
結論:
- 非常に低いLDLコレステロール濃度 (<0. 2mmol/ L) を達成すると,主要な心血管疾患の減少が顕著に表れます.
- 非常に低いLDLコレステロールレベルは,平均2.2年の追跡期間で安全であることが判明しました.
- これらの発見は,現在の推奨値を下回る可能性のある,心臓血管疾患の患者におけるより積極的なLDLコレステロール低下戦略を支持する.
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