DOCSLIB.ORG

Decade in Review—Dyslipidaemia: Resurgence of Targets And

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Decade in Review—Dyslipidaemia: Resurgence of Targets And NEWS & VIEWS DECADE IN REVIEW—DYSLIPIDAEMIA trial.3 Ridker et al. selected patients with an elevated C-reactive protein level (measured Resurgence of targets and by high-sensitivity assay), but who were free from CAD, and demonstrated that a daily compounds to treat dyslipidaemia dose of 20 mg rosuvastatin robustly reduced John J. P. Kastelein the incidence of major adverse cardiovascu- lar events by 44% compared with placebo Over the past decade, we have witnessed the unparalleled success (P <0.00001).3 Again, efficacy was observed of statins to treat dyslipidaemia. Target identification by Mendelian in all subgroups, including men and women, randomization, human monoclonal antibodies, gene therapy, RNA-based the elderly and young, tobacco smokers and targets, and atherogenic lipoproteins other than LDL cholesterol have nonsmokers, and those with or without fuelled intense development efforts that might bear fruit in the very metabolic syndrome. More importantly, the JUPITER trial3 results highlighted the link near future. between inflammation, dyslipidaemia, and Kastelein, J. J. P. Nat. Rev. Cardiol. 11, 629–631 (2014); published online 9 September 2014; atherosclerotic vascular disease, which has doi:10.1038/nrcardio.2014.132 led to the current development of selective anti-inflammatory strategies in outcome When Terje Pedersen first presented the which turned the hypothesis that ‘lower trials by the same research group. results of the Scandinavian Simvastatin LDL cholesterol is better’ into a core princi- In two papers published in 2006 and Survival Study at the AHA Scientific Sessions ple. In the PROVE-IT study,1 Cannon and 2008, respectively, investigators applied on 16 November 1994 in Dallas, TX, USA, co-workers convincingly demonstrated advanced molecular biology techniques he probably did not realize that the study that 80 mg of atorvastatin was superior to to the study of lipid control.4,5 In the first would initiate a global revolution in statin 40 mg of pravastatin in outcome parameters study, mRNA inhibition by subcutaneously therapy. Today, statins are the most widely including death, myocardial infarction, administered small oligonucleotides against prescribed class of drugs, and although the unstable angina, and revascularization (a apolipoprotein B-100 (apoB-100) lowered results of this study were presented 20 years 16% risk reduction in favour or atorvasta tin; the levels of all atherogenic lipoproteins in ago, no other drug has since been shown to P = 0.005), when administered shortly after human volunteers with mild dyslipidaemia.4 have any additional benefit for patients with an acute coronary syndrome (ACS).1 This These results have led to the development dyslipidaemia. Inhibitors of phospholipases, study transformed care for patients with of small inhibitory RNAs, mRNA inhibi- cholesteryl ester transfer protein (CETP), ACS; 80 mg of atorvastatin straight after tors, and locked nucleic acid inhibitors and cholesterol absorption, as well as ago- an ACS episode has now become routine that target angiopoietin-related protein 3, nists of peroxisome pr oliferator-activated clinical practice in coronary care units in apoB-100, apolipoprotein C-III (apoC-III), receptor, thyroxin receptor, and nicotinic most countries. This strategy has saved apolipoprotein(a) [apo(a)], and PCSK9, and acid have either been toxic or not provided innumerable lives of patients with coronary which have all reached phase I and further a beneficial outcome for patients. However, artery disease (CAD) and protected them clinical studies. These developments are just not all discoveries in the past decade for against recurrent events. the beginning, and many more will come in the therapeutic control of dyslipidaemia In the TNT study,2 also published in the next decade. In the second paper, which can be claimed by statins. In 2003, Boileau 2004, LaRosa and colleagues demonstrated garnered little attention when first pub- and colleagues mapped a locus associated that 80 mg was superior to 10 mg of ator- lished, Stroes and colleagues performed the with familial hyper cholesterolaemia in vastatin for treating patients with stable first proof-of-concept study of gene therapy the gene encoding proprotein convertase CAD. High-dose atorvastatin reduced the for dys lipidaemia. Alipogene tiparvovec s ubtilisin/kexin type 9 (PCSK9). As with the primary end point (occurrence of a major increases the removal of postprandial chylo- Scandinavian Simvastatin Survival Study, cardiovascular event) by 22% compared microns, the particles known to cause the Boileau et al. could not have foreseen that with the lower dose of the drug (P <0.001).2 acute and potentially lethal haemor rhagic their discovery would develop into the cur- This study has also enabled many second- pancreatitis associated with the chylo- rently most exciting class of lipid-lowering ary analyses that aid our understanding micro naemia syndrome. Alipogene tipar- drugs—monoclonal antibodies against cir- of renal function during statin therapy, vovec (commercially known as Glybera®; culating PCSK9. These two discoveries have the clinical safety of low LDL-cholesterol UniQure, Netherlands) became the first led to an unprecedented number of devel- levels, and that a reduction in adverse clini- gene therapy product to be approved for any opments in the field of dyslipidaemia in the cal outcomes is independent of almost any indication in the Western world.5 past decade. baseline patient characteristic, including Many developments since 1994 have In 2004, the authors of two papers first LDL-cholesterol level itself. These ‘statin revol ved around the biology, pathology, established the clinical importance of statins principles’ were extended into the realm of and therapeutic lowering of LDL-cholesterol in the treatment of cardiovascular disease, primary prevention in 2008 in the JUPITER levels. Only after a number of international NATURE REVIEWS | CARDIOLOGY VOLUME 11 | NOVEMBER 2014 © 2014 Macmillan Publishers Limited. All rights reserved NEWS & VIEWS 1986 2013 approach in the development of drugs to apoC-III, triglyceride metabolism, and treat dyslipidaemia. CAD risk.9,10 The fact that the apoC-III 450 First Synvinolin Of all the developments over the past inhibitor is already in clinical development 400 study decade, a paper by Stein and colleagues in is, therefore, timely and fortuitous. With all 2012 deserves the title of ‘game changer’. In of these results comes the hope that novel 350 this study, a monoclonal antibody against small-molecule compounds, monoclonal 300 PCSK9 (alirocumab), reduced the relative antibodies, and RNA technology will trans- LDL-cholesterol level by >60% in both form dyslipidaemia treatment in the coming RUTHERFORD 250 volun teers with normal lipid levels and decade, for a second time since 1994. We ENHANCE ASAP patients with familial hypercholesterol- might finally be able to eliminate dys- 200 aemia.8 The excellent safety profile of this lipidaemia and subsequent atherosclerotic RADIANCE drug class has been a relief for clinicians, vascular disease for our patients in the very LDL-C levels (mg/dl) LDL-C levels 150 especially given the previous toxicity- near future. 100 related failures of other compounds. Simi- Department of Vascular Medicine, Academic lar results were obtained in studies with Medical Center, University of Amsterdam, 50 bococizumab and evolocumab, and all three Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. 0 monoclonal antibodies targeted against PCSK9 are already in advanced, phase III [email protected] mg mg mg mg mg statin statin out come trials. Only 9 years have passed Competing interests Eze 10 J.J.P.K. declares that he has acted as a consultant No therapy mg + mg + between Boileau and colleagues’ initial + Simva 40Atorva 80Simva 40Simva 80 and received honouraria from the following mg PCSK9 discovery and Stein and co- workers’ companies: Aegerion, Amgen, AstraZeneca, Torcet 60Evo 420 2012 paper. This rapid development has Atheronova, Boehringer Ingelheim, Catabasis, Simva 80 been made possible by recombinant DNA Cerenis, CSL Behring, Dezima Pharmaceuticals, Eli Lilly, Esperion, Genzyme, Isis, Merck, Novartis, Therapy and antibody technology. Compared with Omthera, Pronova, Regeneron, Sanofi, The Medicines Figure 1 | LDL‑cholesterol levels achieved by the >25 years between cloning of the lipo- Company, UniQure, and Vascular Biogenics. lipid‑lowering therapies developed during the protein lipase (LPL) gene and the LPL gene past 3 decades in patients with familial therapy trial by our own group, the devel- 1. Cannon, C. P. et al. Intensive versus moderate lipid lowering with statins after acute coronary hypercholesterolaemia. Dosing frequencies are opment of PCSK9-based technologies has syndromes. N. Engl. J. Med. 350, 1495–1504 per day unless otherwise stated. Abbreviations: been a remarkable achievement. (2004). Atorva, atorvastatixn; Evo, evolocumab; Eze, However, for which patients is the dis- 2. LaRosa, J. C. et al. Intensive lipid lowering with ezetimibe; LDL‑C, LDL‑cholesterol; Simva, atorvastatin in patients with stable coronary covery of PCSK9 monoclonal antibodies simvastatin; Torcet, torcetrapib. disease. N. Engl. J. Med. 352, 1425–1435 most beneficial in the short term? To have (2005). personally witnessed the ever-decreasing 3. Ridker, P. M. et al. Rosuvastatin to prevent consortia performed large Mendelian LDL-cholesterol levels that different thera- vascular events in men and women with elevated C‑reactive protein.
Load more

Recommended publications
  • 125559Orig1s000
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 125559Orig1s000 PHARMACOLOGY REVIEW(S) Tertiary Pharmacology/Toxicology Review Date: July 14, 2015 From: Timothy J. McGovern, Ph.D., ODE Associate Director for Pharmacology and Toxicology, OND IO BLA: 125559 Agency receipt date: November 24, 2014 Drug: PRALUENT (alirocumab) Sponsor: Sanofi-Aventis U.S. LLC Indication: Adult patients with primary hypercholesterolemia (non-familial and heterozygous familial) or mixed dyslipidemia Reviewing Division: Division of Metabolism and Endocrinology Products Introductory Comments: The pharmacology/toxicology reviewer and supervisor concluded that the nonclinical data support approval of PRALUENT (alirocumab) for the indication listed above. Alirocumab is a human IgG1 monoclonal antibody that binds to human PCSK9 (Proprotein Convertase Subtilisin Kexin Type 9). The recommended Established Pharmacologic Class for alirocumab is PCSK9 inhibitor antibody. There are no approved products in this class currently. An appropriate nonclinical program was conducted by the sponsor to support approval of alirocumab. Alirocumab elicited expected pharmacological responses in rats, hamsters, and monkeys; alirocumab lowered total cholesterol and LDL-cholesterol in the species tested and decreased HDL-cholesterol in rats and hamsters. The primary nonclinical toxicity studies of alirocumab were conducted in rats and monkeys for up to 6 months duration with weekly subcutaneous and intravenous dosing. No significant adverse findings were observed at the doses tested which achieved exposure multiples up to 11-fold in rats and 103-fold in monkeys compared to the maximum recommended human dose of 150 mg alirocumab administered subcutaneously once every two weeks. Findings in the liver and adrenal glands of rats were associated with exaggerated pharmacologic effects.
    [Show full text]
  • (AAV1-LPLS447X) Gene Therapy for Lipoprotein Lipase Deficiency
    Gene Therapy (2013) 20, 361–369 & 2013 Macmillan Publishers Limited All rights reserved 0969-7128/13 www.nature.com/gt ORIGINAL ARTICLE Efficacy and long-term safety of alipogene tiparvovec (AAV1-LPLS447X) gene therapy for lipoprotein lipase deficiency: an open-label trial D Gaudet1,2,JMe´ thot1,2,SDe´ry1, D Brisson1,2, C Essiembre1, G Tremblay1, K Tremblay1,2, J de Wal3, J Twisk3, N van den Bulk3, V Sier-Ferreira3 and S van Deventer3 We describe the 2-year follow-up of an open-label trial (CT-AMT-011–01) of AAV1-LPLS447X gene therapy for lipoprotein lipase (LPL) deficiency (LPLD), an orphan disease associated with chylomicronemia, severe hypertriglyceridemia, metabolic complications and potentially life-threatening pancreatitis. The LPLS447X gene variant, in an adeno-associated viral vector of serotype 1 (alipogene tiparvovec), was administered to 14 adult LPLD patients with a prior history of pancreatitis. Primary objectives were to assess the long-term safety of alipogene tiparvovec and achieve a X40% reduction in fasting median plasma triglyceride (TG) at 3–12 weeks compared with baseline. Cohorts 1 (n ¼ 2) and 2 (n ¼ 4) received 3 Â 1011 gc kg À 1, and cohort 3 (n ¼ 8) received 1 Â 1012 gc kg À 1. Cohorts 2 and 3 also received immunosuppressants from the time of alipogene tiparvovec administration and continued for 12 weeks. Alipogene tiparvovec was well tolerated, without emerging safety concerns for 2 years. Half of the patients demonstrated a X40% reduction in fasting TG between 3 and 12 weeks. TG subsequently returned to baseline, although sustained LPLS447X expression and long-term changes in TG-rich lipoprotein characteristics were noted independently of the effect on fasting plasma TG.
    [Show full text]
  • Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol
    Kristensen et al. BMC Cardiovascular Disorders (2020) 20:336 https://doi.org/10.1186/s12872-020-01616-9 RESEARCH ARTICLE Open Access Lipid-lowering therapy and low-density lipoprotein cholesterol goal attainment after acute coronary syndrome: a Danish population-based cohort study Marie Skov Kristensen1, Anders Green2,3, Mads Nybo4, Simone Møller Hede2, Kristian Handberg Mikkelsen5, Gunnar Gislason1,6,7,8, Mogens Lytken Larsen9 and Annette Kjær Ersbøll1* Abstract Background: Patients with acute coronary syndrome (ACS) are at high risk of recurrent cardiovascular (CV) event. The European guidelines recommend low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/L and early initiation of intensive lipid-lowering therapy (LLT) to reduce CV risk. In order to reduce the risk of further cardiac events, the study aimed to evaluate LDL-C goal attainment and LLT intensity in an incident ACS population. Methods: A cohort study of patients with residency at Funen in Denmark at a first-ever ACS event registered within the period 2010–2015. Information on LLT use and LDL-C levels was extracted from national population registers and a Laboratory database at Odense University Hospital. Treatments and lipid patterns were evaluated during index hospitalization, at 6-month and 12-month follow-up. Results: Among 3040 patients with an LDL-C measurement during index hospitalization, 40.7 and 39.0% attained the recommended LDL-C target value (< 1.8 mmol/L) within 6- and 12-month follow-up, respectively. During 6- and 12-month follow-up, a total of 89.2% (20.2%) and 88.4% (29.7%) used LLT (intensive LLT).
    [Show full text]
  • Repatha) Reference Number: PA.CP.PHAR.123 Effective Date: 01/18 Last Review Date: 01/19 Revision Log
    Clinical Policy: Evolocumab (Repatha) Reference Number: PA.CP.PHAR.123 Effective Date: 01/18 Last Review Date: 01/19 Revision Log Description Evolocumab (RepathaTM) is a proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor antibody. FDA Approved Indication(s) Repatha is indicated: • To reduce the risk of myocardial infarction, stroke, and coronary revascularization in adults with established cardiovascular disease • As an adjunct to diet, alone, or in combination with other lipid-lowering therapies (e.g., statins, ezetimibe), for treatment of adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia) to reduce low-density lipoprotein cholesterol (LDL-C) • As an adjunct to diet and other LDL-lowering therapies (e.g., statins, ezetimibe, LDL apheresis) in patients with homozygous familial hypercholesterolemia (HoFH) who require additional lowering of LDL-C Policy/Criteria Provider must submit documentation (which may include office chart notes and lab results) supporting that member has met all approval criteria It is the policy of health plans affiliated with Pennsylvania Health and Wellness that Repatha is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Heterozygous Familial Hypercholesterolemia and Atherosclerotic Cardiovascular Disease (must meet all): 1. Diagnosis of one of the following (a or b): a. HeFH as defined by one of the following (i or ii): i. World Health Organization (WHO)/Dutch Lipid Network familial hypercholesterolemia diagnostic criteria score of > 8 as determined by requesting provider; ii. Definite diagnosis per Simon Broome criteria); b. Atherosclerotic cardiovascular disease (ASCVD) as evidenced by a history of any one of the following conditions (i-vii): i. Acute coronary syndromes; ii.
    [Show full text]
  • Classification of Medicinal Drugs and Driving: Co-Ordination and Synthesis Report
    Project No. TREN-05-FP6TR-S07.61320-518404-DRUID DRUID Driving under the Influence of Drugs, Alcohol and Medicines Integrated Project 1.6. Sustainable Development, Global Change and Ecosystem 1.6.2: Sustainable Surface Transport 6th Framework Programme Deliverable 4.4.1 Classification of medicinal drugs and driving: Co-ordination and synthesis report. Due date of deliverable: 21.07.2011 Actual submission date: 21.07.2011 Revision date: 21.07.2011 Start date of project: 15.10.2006 Duration: 48 months Organisation name of lead contractor for this deliverable: UVA Revision 0.0 Project co-funded by the European Commission within the Sixth Framework Programme (2002-2006) Dissemination Level PU Public PP Restricted to other programme participants (including the Commission x Services) RE Restricted to a group specified by the consortium (including the Commission Services) CO Confidential, only for members of the consortium (including the Commission Services) DRUID 6th Framework Programme Deliverable D.4.4.1 Classification of medicinal drugs and driving: Co-ordination and synthesis report. Page 1 of 243 Classification of medicinal drugs and driving: Co-ordination and synthesis report. Authors Trinidad Gómez-Talegón, Inmaculada Fierro, M. Carmen Del Río, F. Javier Álvarez (UVa, University of Valladolid, Spain) Partners - Silvia Ravera, Susana Monteiro, Han de Gier (RUGPha, University of Groningen, the Netherlands) - Gertrude Van der Linden, Sara-Ann Legrand, Kristof Pil, Alain Verstraete (UGent, Ghent University, Belgium) - Michel Mallaret, Charles Mercier-Guyon, Isabelle Mercier-Guyon (UGren, University of Grenoble, Centre Regional de Pharmacovigilance, France) - Katerina Touliou (CERT-HIT, Centre for Research and Technology Hellas, Greece) - Michael Hei βing (BASt, Bundesanstalt für Straßenwesen, Germany).
    [Show full text]
  • Clinical Policy: Evolocumab (Repatha) Reference Number: CP.CPA.269 Effective Date: 10.15 Last Review Date: 02.19 Line of Business: Commercial Revision Log
    Clinical Policy: Evolocumab (Repatha) Reference Number: CP.CPA.269 Effective Date: 10.15 Last Review Date: 02.19 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description Evolocumab (Repatha®) is a proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor antibody. FDA Approved Indication(s) Repatha is indicated: • To reduce the risk of myocardial infarction, stroke, and coronary revascularization in adults with established cardiovascular disease • As an adjunct to diet, alone, or in combination with other lipid-lowering therapies (e.g., statins, ezetimibe), for treatment of adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia) to reduce low-density lipoprotein cholesterol (LDL-C) • As an adjunct to diet and other LDL-lowering therapies (e.g., statins, ezetimibe, LDL apheresis) in patients with homozygous familial hypercholesterolemia (HoFH) who require additional lowering of LDL-C Policy/Criteria Provider must submit documentation (such as office chart notes, lab results or other clinical information) supporting that member has met all approval criteria. It is the policy of health plans affiliated with Centene Corporation® that Repatha is medically necessary when the following criteria are met: I. Initial Approval Criteria A. Heterozygous Familial Hypercholesterolemia and Atherosclerotic Cardiovascular Disease (must meet all): 1. Diagnosis of one of the following (a or b): a. HeFH as defined by one of the following (i or ii): i. World Health Organization (WHO)/Dutch Lipid Network familial hypercholesterolemia diagnostic criteria score of > 8 as determined by requesting provider (see Appendix D); ii. Definite diagnosis per Simon Broome criteria (see Appendix D); b.
    [Show full text]
  • Background A. Rodríguez-Alarcón1, C. López1, E. González-Colominas1
    LONG-TERM EFFICACY, SAFETY AND ADHERENCE TO ALIROCUMAB IN PATIENTS WITH DYSLIPIDAEMIA FROM A TERTIARY HOSPITAL COHORT A. Rodríguez-Alarcón1, C. López1, E. González-Colominas1, S. Luque1, Ll. Recasens2, J. Pedro-Botet3, A. Oliveras4, R. González1, L. Tarrason1, S. Grau1 1Pharmacy Department. Parc de Salut Mar. Barcelona. 2Cardiology Department. Parc de Salut Mar. Barcelona. 3Endocrinology Department. Parc de Salut Mar. Barcelona. 4Nephrology Department. Parc de Salut Mar. Barcelona. Key words: Alirocumab, efficacy, safety, adherence Abstract number: 4CPS-023 ATC code: C10 - Lipid modifying agents Background Alirocumab is a monoclonal antibody approved for the treatment of hypercholesterolemia but long-term clinical data are still limited. Objectives To assess the long-term efficacy, safety and adherence to alirocumab after 96 weeks of treatment in a cohort of patients with dyslipidemia. Material and methods Retrospective observational study performed in a university tertiary hospital. All patients starting alirocumab before September 2017 in our institution and treated for at least 96 weeks were included. Data collected: demographic, clinical and alirocumab data, including treatment efficacy (% LDLc reduction from baseline to 96 weeks) and adherence (Medication Possession Ratio). Results Thirty-three patients started alirocumab treatment during 2017 being 31 (93.9%) still on treatment after 96 weeks. Two patients (6.1%) discontinued therapy: one due to an active malignancy and one due to loss of follow-up. Demographic LDLc reduction Adherence Men, % 58,1 Age (years), median (IQR) 65 (11) Alirocumab 75 mg/2 weeks, % 87,1 Alirocumab 150 mg/2 weeks, % 12,9 Secondary prevention, % 83,9 High cardiovascular risk, % 80,6 Efficacy: LDLc reduction (median (IQR)): 59.5 Median (range) adherence: 100% Type of hypercholesterolemia, %: (22.6%).
    [Show full text]
  • Intervention to Improve LDL Receptor Function Emerging Therapies
    Intervention to improve LDL receptor function Emerging Therapies Marina Cuchel, MD, PhD Perelman School of Medicine University of Pennsylvania Most Lipid Lowering Drugs Affect LDL-C Levels By Up-Regulating the LDLR B100 apoB MTP VLDL TG TG statins ezetimibe bile acid sequestrants IDL PCSK9 -inhibitors LDL TG Cuchel NLA 2017 Do we really need more LDL-C lowering drugs? • LDL-C still not a goal with existing LLTs in a significant portion of subjects • Drug intolerance (statins) • Cost of new treatments • Other reasons Cuchel NLA 2017 Outline • PCSK9 – beyond monoclonal antibodies • ETC-1002 – inhibiting upstream HMGCoAR • Replacing LDLR - Gene therapy • ANGPTL3 inhibitors and other drug affecting LDL production Cuchel NLA 2017 PCSK9 enhances LDLR degradation Cuchel NLA 2017 Use of PCSK9i is complementary to that of statins PCSK9i evolucumab alirocumab [other monoclonal ABs] statins HMG-CoA ↑LDLR ↑PCSK9 ↓LDL-C ↓Cholesterol Cuchel NLA 2017 PCSK9 inhibition is very effective in lowering LDL-C Sabatine MS et al. N Engl J Med 2017. DOI: 10.1056/NEJMoa1615664 Cuchel NLA 2017 PCSK9 – beyond monoclonal Antibodies • Monoclonal PCSK9i are expensive • Require high doses • Are injectable • ?May lose responsiveness over time? Cuchel NLA 2017 Targeting PCSK9 with novel strategies • Vaccines • siRNA • Small molecules Cuchel NLA 2017 Targeting PCSK9 with novel strategies Vaccines antibodies response SREBP-2 pathway ↑ HMGCoA Red ↑ LDL-R Target protein ↑Epitope PCSK9 identification Conjugation with Administration Antibodies foreign peptide production Clinicaltrials.gov NCT02508896 Cuchel NLA 2017 Vaccine against PCSK9 lowers LDL-C in primates Crossey E. Vaccine, 2015 , 33, 5747–5755 Cuchel NLA 2017 Targeting PCSK9 with novel strategies siRNA SREBP-2 pathway ↑ HMGCoA Red ↑ LDL-R ↓PCSK9 Gene silencing Clinicaltrials.gov NCT02597127, NCT02314442 Cuchel NLA 2017 The RNAi inhibitor of PCSK9 - inclisiran - lowers PCSK9 and LDL-C levels in humans Ray KK et al.
    [Show full text]
  • PCSK9 Inhibitor Non-Response in a Patient with Preserved LDL Receptor
    PCSK9 inhibitor non-response in a patient with preserved LDL receptor function: A case study Losh C, Underberg J Murray Hill Medical Group and New York University School of Medicine, New York, NY Background Results Conclusions PCSK9 inhibitors (PCSK9Is) are monoclonal LDL-C levels after three and seven weeks Absence of LDL receptor activity is not the antibodies that bind to serum PCSK9 and Response to Statin Therapy of therapy with alirocumab 75 mg were 235 only mechanism of PCSK9 inhibitor non- delay LDL receptor degradation. Two mg/dL and 239 mg/dL respectively. Three response. An alteration in the PCSK9 PCSK9Is are commercially available: and seven weeks after up-titration, LDL-C Intervention LDL-C (mg/dL) Change (%) evolocumab and alirocumab. FDA approved binding site for alirocumab and indications include LDL cholesterol (LDL-C) was 249 mg/dL and 292 mg/dL, evolocumab is proposed as a hypothetical lowering on maximally tolerated statin respectively. Total duration of alirocumab None 283 — mechanism for non-response in this therapy was 16 weeks. LDL-C was 253 therapy in patients with ASCVD and Familial patient. Other alternatives include Hypercholesterolemia (FH). Among patients mg/dL after 3 weeks of therapy with pitavastatin 2 mg 238 -15.9% immunogenicity, noncompliance, or faulty with LDL receptor mutations, those with evolocumab, at which time PCSK9 1 dose/week partial loss of function typically respond well inhibitor therapy was discontinued due to pitavastatin 2 mg injection techniqueReferences. 216 -23.7% to PCSK9 inhibition, while those with lack of clinical response. 2 doses/week Amgen Inc. (2015). Repatha: Highlights of homozygous receptor-negative mutations, pitavastatin 2 mg ie.
    [Show full text]
  • 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias
    Atherosclerosis 290 (2019) 140–205 Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid ☆ T modification to reduce cardiovascular risk ∗ ∗∗ Authors/Task Force Members (François Macha, ,2, Colin Baigentb, ,2, ∗∗∗ Alberico L. Catapanoc, ,1,2, Konstantinos C. Koskinasd, Manuela Casulae,f,1, Lina Badimong, M. John Chapmanh,i,cm,1, Guy G. De Backerj, Victoria Delgadok, Brian A. Ferencel, Ian M. Grahamm, Alison Hallidayn, Ulf Landmessero,p,q, Borislava Mihaylovar,s, Terje R. Pedersent, Gabriele Riccardiu,1, Dimitrios J. Richterv, Marc S. Sabatinew, Marja-Riitta Taskinenx,1, Lale Tokgozogluy,1, Olov Wiklundz), ESC National Cardiac Societies (Djamaleddine Nibouchean, Parounak H. Zelveianao, Peter Siostrzonekap, Ruslan Najafovaq, Philippe van de Bornear, Belma Pojskicas, Arman Postadzhiyanat, Lambros Kyprisau, Jindřich Špinarav, Mogens Lytken Larsenaw, Hesham Salah Eldinax, Margus Viigimaaay, Timo E. Strandbergaz, Jean Ferrièresba, Rusudan Agladzebb, Ulrich Laufsbc, Loukianos Rallidisbd, László Bajnokbe, Thorbjörn Gudjónssonbf, Vincent Maherbg, Yaakov Henkinbh, Michele Massimo Guliziabi, Aisulu Mussagaliyevabj, Gani Bajraktaribk, Alina Kerimkulovabl, Gustavs Latkovskisbm, Omar Hamouibn, Rimvydas Slapikasbo, Laurent Visserbp, Philip Dinglibq, Victoria Ivanovbr, Aneta Boskovicbs, Mbarek Nazzibt, Frank Visserenbu, Irena Mitevskabv, Kjetil Retterstølbw, Piotr Jankowskibx, Ricardo Fontes-Carvalhoby, Dan Gaitabz, Marat Ezhovca,
    [Show full text]
  • Praluent® (Alirocumab)
    Praluent® (alirocumab) – New orphan indication • On April 1, 2021, the FDA approved Regeneron’s Praluent (alirocumab), as an adjunct to other low density lipoprotein cholesterol (LDL-C)-lowering therapies in adult patients with homozygous familial hypercholesterolemia (HoFH) to reduce LDL-C. • Praluent is also approved: — To reduce the risk of myocardial infarction, stroke, and unstable angina requiring hospitalization in adults with established cardiovascular disease. — As an adjunct to diet, alone or in combination with other LDL-C-lowering therapies, in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH), to reduce LDL-C. • The approval of Praluent for the new indication was based on ODYSSEY HoFH, a double-blind, placebo-controlled study in 45 adult patients with HoFH. Patients were taking maximally tolerated doses of statins with or without other lipid-lowering therapy and required additional LDL-C reduction. Patients were randomized to Praluent or placebo. — At week 12, the treatment difference between Praluent and placebo in mean LDL-C percent change from baseline was -36% (95% CI: -51, -20; p < 0.0001). • The recommended dose of Praluent for the treatment of HoFH is 150 mg once every 2 weeks administered subcutaneously. — LDL-C should be assessed when clinically appropriate. The LDL-lowering effect of Praluent may be measured as early as 4 weeks after initiation. — Refer to the Praluent drug label for dosing for its other indications optumrx.com ® OptumRx specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. ® We are an Optum company — a leading provider of integrated health services. Learn more at optum.com.
    [Show full text]
  • Praluent (Alirocumab) Repatha (Evolocumab) Effective 12/1/2019
    Praluent (alirocumab) Repatha (evolocumab) Effective 12/1/2019 ☒ MassHealth Plan ☒ ☒Commercial/Exchange Prior Authorization Program Type ☐ Quantity Limit ☒ Pharmacy Benefit Benefit ☐ Step Therapy ☐ Medical Benefit (NLX) Specialty N/A Limitations Specialty Medications All Plans Phone: 866-814-5506 Fax: 866-249-6155 Non-Specialty Medications Contact MassHealth Phone: 877-433-7643 Fax: 866-255-7569 Information Commercial Phone: 800-294-5979 Fax: 888-836-0730 Exchange Phone: 855-582-2022 Fax: 855-245-2134 Medical Specialty Medications (NLX) All Plans Phone: 844-345-2803 Fax: 844-851-0882 Exceptions N/A Overview Alirocumab (Praluent) and evolocumab (Repatha) are human monoclonal antibodies that bind to proprotein convertase subtilisin kexin type 9 (PCSK9). PCSK9 binds to LDL-receptors (LDLR) on the surface of hepatocytes to promote LDLR degradation in the liver. LDLR is the primary receptor that clears LDL; therefore, the decrease in LDLR levels by PCSK9 results in increased blood levels of LDL- C. By inhibiting PCSK9 binding to LDLR, these medications increase the number of LDLRs to lower LDL-C levels. Approvable Indications Alirocumab (Praluent) 1. Adjunct to diet and maximally tolerated statin therapy for the treatment of adults with Heterozygous Familial Hypercholesterolemia (HeFH) 2. Clinical atherosclerotic cardiovascular disease (ASCVD), who require additional lowering of low- density lipoprotein (LDL)-cholesterol (LDL-C). 3. To reduce the risk of serious cardiovascular events (e.g., MI, stroke and unstable angina) requiring hospitalization in adults with established cardiovascular disease. 4. Secondary prevention of cardiovascular events: To reduce the risk of MI, stroke, and unstable angina requiring hospitalization in adults with established cardiovascular disease Evolocumab (Repatha) 1.
    [Show full text]