New safety and efficacy data for two proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors show that patients at high cardiovascular (CV) risk reach target LDL-cholesterol (LDL-C) levels safely on these therapies. [Hollstein T, et al, AHA 2017, abstract M1094]

“[This is the] first independent real-world study comparing the efficacy and safety of all three available PCSK9 inhibitors,” said researchers from the Charite Universitasmedizin in Berlin, Germany.

The prospective, observational study included 499 patients who had either very high CV risk or familial hypercholesterolaemia plus family history of early CV disease, who had not achieved the LDL-C goal of 70 mg/dL despite maximally tolerated lipid-lowering therapy.

Patients were randomized to receive evolocumab (140 mg Q2W) or alirocumab (150 mg Q2W, or 75 mg in patients with lower baseline LDL-C) alongside conventional lipid-lowering therapy.

Mean LDL-C at baseline was 161 mg/dL. After 1 month of PSCK9 inhibitor treatment, LDL-C was reduced by 91.3 mg/dL, 93.2 mg/dL and 64.4 mg/dL in the evolocumab, alirocumab, and low-dose alirocumab groups, respectively, with all patients reaching the target LDL-C level.

LDL-C remained stable after 17 months of follow-up in patients who did not change their lipid-lowering regimens.

“[Diabetic] patients with high triglycerides can take advantage of an increased triglyceride reduction in [very-low-density lipoprotein] by PCSK9 inhibitors,” the researchers noted.