Chronic Inflammatory Demyelinating Polyradiculoneuropathy Association With Low Cholesterol Levels: A Case Report in a Patient Taking PCSK9 Inhibitor

Franco, Diana Carolina; Neupane, Neelam; Riaz, Maria; Mohammadzadeh, Sanaz; Sachmechi, Issac

doi:10.14740/jnr552

Cited by 5 publications

(6 citation statements)

References 8 publications

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“…There are no published data on neuropathy outcomes with bile acid sequestrants or PCSK9i. Concerns have been raised regarding very low levels of LDL-C and the risk of peripheral neuropathy [111] and there is a case report of neuropathy associated with a marked reduction in LDL-C with PCSK9i [112]. This was not supported by a pooled analysis of 10 ODYSSEY trial phase 3 trials [113].…”

Section: Lipid Therapeutics Targeting Neuropathymentioning

confidence: 99%

Lipids and peripheral neuropathy

Iqbal

Bashir

Ferdousi

et al. 2021

Current Opinion in Lipidology

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Purpose of review Hyperlipidaemia is associated with the development of neuropathy. Indeed, a mechanistic link between altered lipid metabolism and peripheral nerve dysfunction has been demonstrated in a number of experimental and clinical studies. Furthermore, post hoc analyses of clinical trials of cholesterol and triglyceride-lowering pharmacotherapy have shown reduced rates of progression of diabetic neuropathy. Given, there are currently no FDA approved disease-modifying therapies for diabetic neuropathy, modulation of lipids may represent a key therapeutic target for the treatment of diabetic nerve damage. This review summarizes the current evidence base on the role of hyperlipidaemia and lipid lowering therapy on the development and progression of peripheral neuropathy. Recent findings A body of literature supports a detrimental effect of dyslipidaemia on nerve fibres resulting in somatic and autonomic neuropathy. The case for an important modulating role of hypertriglyceridemia is stronger than for low-density lipoprotein cholesterol (LDL-C) in relation to peripheral neuropathy. This is reflected in the outcomes of clinical trials with the different therapeutic agents targeting hyperlipidaemia reporting beneficial or neutral effects with statins and fibrates. The potential concern with the association between proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy and cognitive decline raised the possibility that extreme LDL-C lowering may result in neurodegeneration. However, studies in murine models and data from small observational studies indicate an association between increased circulating PCSK9 levels and small nerve fibre damage with a protective effect of PCSK9i therapy against small fibre neuropathy. Additionally, weight loss with bariatric surgery leads to an improvement in peripheral neuropathy and regeneration of small nerve fibres measured with corneal confocal microscopy in people with obesity with or without type 2 diabetes. These improvements correlate inversely with changes in triglyceride levels. Summary Hyperlipidaemia, particularly hypertriglyceridemia, is associated with the development and progression of neuropathy. Lipid modifying agents may represent a potential therapeutic option for peripheral neuropathy. Post hoc analyses indicate that lipid-lowering therapies may halt the progression of neuropathy or even lead to regeneration of nerve fibres. Well designed randomized controlled trials are needed to establish if intensive targeted lipid lowering therapy as a part of holistic metabolic control leads to nerve fibre regeneration and improvement in neuropathy symptoms.

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Section: Lipid Therapeutics Targeting Neuropathymentioning

confidence: 99%

Lipids and peripheral neuropathy

Iqbal

Bashir

Ferdousi

et al. 2021

Current Opinion in Lipidology

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“…It is worth mentioning, that a neurological complication, namely peripheral neuropathy has been described in subjects with prediabetes after application of PCSK9i ( 21 ). The role of PCSK9 and PCSK9 inhibition in the peripheral nervous system has been recently summarised ( 22 ).…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Case Report: Neurological adverse events in subject with myasthenia gravis after PCSK9 inhibitor administration

Adámková,

Vitásková,

Hubáček

2024

Front. Cardiovasc. Med.

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BackgroundMyasthenia gravis is a rare chronic autoimmune neuromuscular disorder mainly caused by autoantibodies to the nicotinic acetylcholine receptor. Cholesterol is an essential molecule that affects the distribution and proper functioning of this receptor. Several reports have described the potential worsening of myasthenia gravis in patients treated with statins.Case presentationThe patient was an obese 72 years old man, past smoker, diagnosed with ischaemic heart disease, type 2 diabetes mellitus and lipid metabolism disorder. Statin treatment was not implemented because of chronic myasthenia gravis and PCSK9i monotherapy [Repatha (evolucamab), 140 mg] was implemented to treat dyslipidaemia. Within 24 h after the first dose of PCSK9i the patient developed severe muscle weakness, joint pain, fever, and general discomfort, lasting for several days. Despite strong advice against the second dose administration, this was self-administered approximately 2 weeks later, leading to report significant worsening of the muscle problems, leading to the patient admittion to the neurology department where he was being treated for myasthenia gravis attack.ConclusionBased on the neurologist's conclusion, it can be assumed that in this case, treatment with PCSK9i resulted in significant worsening of the patient's chronic disease.

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“…2 ). Incidentally, a recent case has reported a patient with a history of prediabetes and dyslipidemia treated with PCSK9 inhibitors who developed peripheral neuropathy ( 60 ). The patient started evolocumab treatment due to statin intolerance.…”

Section: Pcsk9 In the Peripheral Nervous Systemmentioning

confidence: 99%

PCSK9 and the nervous system: a no-brainer?

Jaafar,

Techer,

Chemello

et al. 2023

Journal of Lipid Research

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Chronic Inflammatory Demyelinating Polyradiculoneuropathy Association With Low Cholesterol Levels: A Case Report in a Patient Taking PCSK9 Inhibitor

Cited by 5 publications

References 8 publications

Lipids and peripheral neuropathy

Lipids and peripheral neuropathy

Case Report: Neurological adverse events in subject with myasthenia gravis after PCSK9 inhibitor administration

PCSK9 and the nervous system: a no-brainer?

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