Evolocumab: Considerations for the Management of Hyperlipidemia

Abstract

PCSK9 inhibitors are a class of lipid-lowering agents that significantly reduce low-density lipoprotein cholesterol (LDL-C) levels in patients with atherosclerotic cardiovascular disease and hyperlipidemia. Evolocumab is a monoclonal antibody that inhibits PCSK9 and has been evaluated in phase II and III studies as monotherapy, in combination with statins and other lipid-lowering therapies, in patients who are statin intolerant, and in patients with heterozygous and homozygous familial hypercholesterolemia. Data from these studies show that evolocumab significantly reduces LDL-C levels. Treatment with evolocumab also significantly improves levels of other lipid parameters (e.g., apolipoproteins A1 and B, lipoprotein(a), non-high-density lipoprotein cholesterol, and triglycerides). Recent results indicate that LDL-C reduction with evolocumab significantly reduces the risk of cardiovascular events and is also associated with atherosclerotic plaque regression. From a safety standpoint, rates of adverse events (AEs), serious AEs, and AEs leading to discontinuation were similar between evolocumab and controls in clinical trials, and no increase in AEs was observed when evolocumab was used in combination with statins. Patients with elevated LDL-C benefit from evolocumab treatment, suggesting that evolocumab could help meet an unmet medical need in high-risk patient populations with atherosclerotic cardiovascular disease and hyperlipidemia that are unable to reduce LDL-C levels sufficiently with statin therapy alone.

Erchen decoction for hyperlipemia

“…[ 20 ] It is reported that some drugs which is used to reduce cardiovascular risk factors may have adverse effects. [ 21 ] For example, some patients show intolerance to statins, [ 22 ] so it is always controversial to use statins as the first lipid-lowering drugs in clinical practice. [ 23 ] More studies have shown that ECD can not only control blood lipid levels, but also effectively relieve symptoms such as dizziness and chest tightness in patients with hyperlipidemia.…”

New Trends Approved in Management of Dyslipidaemia

“…The strategies that target the binding include: a) Monoclonal antibodies (mAbs) that bind to PCSK9 in the plasma, thereby preventing it from binding to LDL-R. LDL reduction: up to a 55% as monotherapy, and 75% combined with a statin [63][64][65][66][67][68] (Figure 8) & (Table 9 & 10).…”

Familial Hypercholesterolemia: New Horizons for Diagnosis and Effective Management

“…Overall, evolocumab appears to offer an attractive treatment option for both HeFH and HoFH, even in statin-intolerant patients and apart from significantly lowering LDL, it also improves ApoA1, ApoB, Lp(a), non-HDL cholesterol, and triglycerides, ultimately leading to atherosclerotic plaque regression (Wiggins et al, 2018 ) and may be an alternative solution for FH patients who cannot undergo lipoprotein apheresis. Indeed, a recent study with a small number of participants reported that lipoprotein apheresis showed no superiority on LDL reduction over evolocumab (Lappegard et al, 2016 ).…”