ODYSSEY OUTCOMESにおける脳卒中のアリロキュマブの影響

J Wouter Jukema¹, Laurien E Zijlstra¹, Deepak L Bhatt²

¹Department of Cardiology, Leiden University Medical Center, The Netherlands (J.W.J., L.E.Z.).

Circulation

|November 12, 2019

まとめ

アリロキュマブは,最近急性冠動脈症候群に罹患した患者の血性脳卒中のリスクを有意に低下させた. このPCSK9阻害剤は,非常に低いLDL- C値であっても,出血性脳卒中のリスクを増加させなかった.

科学分野:

心血管医学
神経学
薬理学について

背景:

LDL-Cを含むアテロゲン性リポタンパク質の低下は,不全性脳卒中のリスクを軽減します.
非常に低いLDL-Cレベルと出血性脳卒中のリスクに関する懸念があります.
ODYSSEY OUTCOMES試験では,スタチンの治療にもかかわらず,最近急性冠動脈症候群と高いLDL- Cを患った患者にアリロキュマブを試験した.

研究の目的:

アリロキュマブが血栓性脳卒中と出血性脳卒中の両方に与える影響を評価する.
アリロキュマブの脳卒中に対する効果が,初期LDL-C値や脳血管疾患の歴によって変化するかどうかを判断する.
アリロキュマブで治療された患者で,非常に低いLDL- Cと出血性脳卒中のリスクとの関連性を評価する.

主な方法:

アリロキュマブとプラセボのランダム化比較
非致死性または致死性不全性および出血性脳卒中のリスクの評価
分析の階層化は,ベースラインのLDL-Cと脳血管疾患の経歴による.

主要な成果:

アリロキュマブは,出血性脳卒中のリスク (HR 0. 83) を増加させることなく,どんな脳卒中 (HR 0. 72) と不全性脳卒中 (HR 0. 73) のリスクを低下させました.
治療効果は,異なるベースラインのLDL- C値と,脳血管疾患の既往歴のある患者でも同じであった.
アリロキュマブ群では,非常に低いLDL- Cと出血性脳卒中の発生率との間に有害な関連は観察されなかった.

結論:

アリロキュマブは,発症時のLDL- C値や脳動脈病歴に関係なく,急性冠動脈症候群および脱脂症患者の脳卒中リスクを低下させた.
血行性脳卒中のリスクは,アリロキュマブ治療群で達成されたLDL- C値に依存しませんでした.

キーワード:

急性冠動脈症候群脳血管疾患脂質タンパク質,LDL ストローク

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