PCSK9 inhibitors in clinical practice: novel directions and new experiences

Abstract Background In randomized clinical trials, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) effectively reduce low-density lipoprotein-cholesterol (LDL-C) with a favorable tolerability and safety profile. Our purpose is to provide real-world data regarding the indications, efficacy and safety of PCSK9i. Methods The cohort comprised 141 patients who attended the lipid clinic of 3 hospitals in Greece and started using PCSK9i. Patients were requested to attend the lipid clinic at 3 months and at one year. Results Ninety percent of patients had heterozygous familial hypercholesterolaemia (heFH) and 75% had cardiovascular disease (CVD). A PCSK9i [evolocumab 140 mg/2 weeks (n=82), alirocumab 75 mg/2 weeks (n=46) and alirocumab 150 mg/2 weeks (n=13)] was prescribed due to failure to achieve LDL-C targets despite maximum lipid-lowering therapy (LLT) in 75% of patients while in the rest of cases the indication was statin intolerance. The mean reduction of LDL-C at 3 months was 56.2% and remained unchanged at 12 months (55.8% reduction from baseline). LDL-C target was achieved by 68.1% of patients at 3 months. “Totally” intolerable to statins patients (unable to tolerate any statin dose, n=23) showed the lowest LDL-C reduction (47.7%). Side effects attributed to treatment were reported by 14 patients (10%). The total number of patients who stopped PCSK9i at one year was 14 (10%) but only 2 (1.4%) discontinued treatment because of side effects (myalgias). Conclusions Our real-world results of PCSK9i showed comparable efficacy and tolerability to those reported in clinical trials and highlight the value of treatment with PCSK9i heFH patients not achieving LDL-C targets despite maximum LLT and high or very high risk statin intolerant patients.