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FDA has approved add-on therapy to lower cholesterol for adults with heterozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease


FDA ( Food and Drug Administration ) has approved Leqvio ( Inclisiran ) injection as a treatment to be used along with diet and maximally tolerated statin therapy for adults with heterozygous familial hypercholesterolemia ( HeFH ) or clinical atherosclerotic cardiovascular disease ( ASCVD ) who require additional lowering of low-density lipoprotein cholesterol ( LDL-C ).
Leqvio works to reduce circulating levels of LDL-C.

Leqvio is approved at a 284 mg dose administered as an initial under-the skin injection, a second dose at three months, and continued treatment once every six months after that point.

Heterozygous familial hypercholesterolemia is a life-threatening condition in which patients have a mutation in a small group of genes that controls the way the body clears cholesterol. As a result, patients have extremely high levels of LDL-C.
People with HeFH generally have cholesterol levels two to three times higher than normal. These individuals are at increased risk of cardiovascular events, such as myocardial infarction, stroke, and coronary artery disease.
HeFH occurs in approximately 1 in 250 individuals.

The effectiveness of Leqvio was studied in three randomized, double-blind, placebo-controlled trials that enrolled 3,457 adults with HeFH or clinical ASCVD. Enrolled participants were taking maximally tolerated statin therapy but required additional LDL-C lowering based on their risk for cardiovascular events.
In all three studies, the main effectiveness outcome measure was the percent change in LDL-C from the beginning of the trial to day 510 ( month 17 ). In each trial, participants received under-the-skin injections of either 284 mg Leqvio or a placebo on four separate days: day 1, day 90 ( month 3 ), day 270 ( month 9 ), and day 450 ( month 15 ).

Study 1 enrolled 1,561 adults with ASCVD. At day 510, the Leqvio group had an average LDL-C decrease of 51% whereas the placebo group had an average LDL-C increase of 1%.

Study 2 enrolled 1,414 adults with ASCVD. At day 510, the Leqvio group had an average LDL-C decrease of 46% whereas the placebo group had an average LDL-C increase of 4%.

Study 3 enrolled 482 adults with HeFH. At day 510, the Leqvio group had an average LDL-C decrease of 40% whereas the placebo group had an average LDL-C increase of 8%.

The effect of Leqvio on cardiovascular morbidity and mortality has not been determined.

Common side effects of Leqvio include injection site reaction, joint stiffness, urinary tract infection, diarrhea, bronchitis, pain in extremity, and difficulty breathing.

Atherosclerotic cardiovascular disease involves the buildup of cholesterol plaque in arteries.
Approximately 18.3 million American adults ( 8% ) have atherosclerotic cardiovascular disease.
Clinical atherosclerotic cardiovascular disease is an umbrella term and includes conditions such as acute coronary syndromes ( sudden, reduced blood flow to the heart ), peripheral arterial disease, myocardial infarction and stroke. ( Xagena )

Source: FDA, 2021

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