Two anti-proprotein convertase subtilisin/kexin type 9 ( PCSK9 ) monoclonal antibodies, Alirocumab and Evolocumab, have been approved for the treatment of hypercholesterolaemia in certain patients.
Data from phase 3 studies to evaluate the efficacy and safety of these antibodies were reviewed.
Researchers identified 12 studies of Alirocumab and 9 of Evolocumab, including over 10 000 patients overall. Most studies enrolled patients with hypercholesterolaemia and used anti-PCSK9 antibodies with statins.
The ODYSSEY FH I, FH II and HIGH FH Alirocumab studies and the RUTHERFORD-2 Evolocumab study exclusively recruited patients with heterozygous familial hypercholesterolaemia.
Two Evolocumab studies focused mainly on homozygous familial hypercholesterolaemia ( HoFH ): TESLA Part B and TAUSSIG ( a TESLA sub-study ); only data for HoFH are reported here.
All comparator studies demonstrated a reduction in LDL cholesterol ( LDL-C ) with the anti-PCSK9 antibodies.
No head to head studies were conducted between Alirocumab and Evolocumab.
Up to 87% of patients receiving Alirocumab and up to 98% receiving Evolocumab reached LDL-C goals.
Both antibodies were effective and well tolerated across a broad population of patients and in specific subgroups, such as those with type 2 diabetes.
In conclusion, using anti-PCSK9 antibodies as add-on therapy to other lipid-lowering treatments or as monotherapy for patients unable to tolerate statins may help patients with high cardiovascular risk to achieve their LDL-C goals. ( Xagena )
Gouni-Berthold I et al, Br J Clin Pharmacol 2016; Epub ahead of print