New and Future Parenteral Therapies for the Management of Lipid Disorders

Cardiovascular disease (CVD) is the leading cause of death in the world. According to the World Health Organization, an estimated 17.9 million people died from CVD in 2016, representing 31% of all global deaths. Of these deaths, 5% are due to myocardial infarction and stroke. Dyslipidemia is known as the major risk factor of atherosclerotic cardiovascular disease. With current therapies, about 60% of high-risk CVD patients do not achieve LDL-C goals, and in patients with familiar hypercholesterolemia (FH) at maximum intensity statin treatment, only 20% achieve LDL-C goals. We discuss new and future parenteral therapies for the management of lipid disorders.

Alipogene tiparvovec: a review of its use in adults with familial lipoprotein lipase deficiency

Alipogene tiparvovec (Glybera®; AMT-011, AAV1-LPL(S447X)) is an adeno-associated virus serotype 1-based gene therapy for adult patients with familial lipoprotein lipase (LPL) deficiency (LPLD) and suffering from severe or multiple pancreatitis attacks despite dietary fat restrictions. It is administered as a one-time series of intramuscular injections in the legs. LPLD, a rare autosomal recessive disorder, results in hyperchylomicronaemia and severe hypertriglyceridaemia, which in turn, are associated with an increased risk of clinical complications, the most debilitating of which is recurrent severe and potentially life-threatening pancreatitis. In clinical studies (n = 27 patients), one-time administration of alipogene tiparvovec was associated with significant reductions in plasma triglyceride levels during the 12 or 14 week study period post administration. Although triglyceride levels returned to pre-treatment levels within 16-26 weeks after administration, patients had sustained improvements in postprandial chylomicron metabolism, with sustained expression of functional copies of the LPL (S477X) gene and of biologically active LPL in skeletal muscle. Moreover, after up to 6 years' follow-up post administration, there were clinically relevant reductions in the incidence of documented pancreatitis and acute abdominal pain events consistent with pancreatitis. Alipogene tiparvovec was generally well tolerated, with most adverse events being localized, transient, mild to moderate injection-site reactions. This article reviews the pharmacology of alipogene tiparvovec and its efficacy and safety in adults with LPLD.