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Xi X, Wang X, Xie W, Jia Y, Sanchez SZ, Martinez L, Zhao Q. Comparison of Evolocumab and Ezetimibe, Both Combined with Statin Therapy, for Patients with Recent Acute Coronary Syndrome: A Cost-Effectiveness Analysis from the Chinese Healthcare Perspective. Cardiovasc Drugs Ther 2023; 37:905-916. [PMID: 35467312 DOI: 10.1007/s10557-021-07276-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the cost-effectiveness of evolocumab, a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor, compared with ezetimibe, both added to background statin therapy in patients with recent acute coronary syndrome (ACS) events (in the past 12 months) and low-density lipoprotein cholesterol (LDL-C) levels ≥ 100 mg/dL in China. METHODS A health economic evaluation was performed from a Chinese healthcare perspective, using a Markov model over a lifetime horizon based on a baseline cardiovascular (CV) event rate from claims database data and efficacy from the FOURIER trial. The health benefit was reflected in the decrease of LDL-C level, which led to a decrease of cardiovascular events. The costs of cardiovascular events and the utility value of each health state were derived from the published literature. Sensitivity analyses were conducted to evaluate the effects of uncertainty in parameters and the robustness of the model. The cost-effectiveness of evolocumab was also explored in patients with recent myocardial infarction (MI), at very high risk (VHR) of atherosclerotic cardiovascular disease (ASCVD), and homozygous familiar hypercholesterolemia (HoFH). RESULTS In patients with recent ACS, evolocumab was associated with incremental quality-adjusted life-years (QALYs) of 1.33 and incremental costs of 115,782 yuan versus ezetimibe, both with background statin therapy, resulting in an incremental cost-effectiveness ratio (ICER) of 87,050 yuan per QALY gained. The probability of evolocumab + statins being cost-effective at a threshold of 217,341 yuan (three times per capita GDP, 2020), compared with ezetimibe + statins, was 100% in patients with recent ACS, recent MI, VHR ASCVD, and HoFH. CONCLUSION Compared with ezetimibe + statins, the combination of evolocumab + statins was found to be cost-effective at a threshold of 217,341 yuan (three times per capita GDP, 2020) in patients with recent ACS events in China.
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Affiliation(s)
- Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Xin Wang
- School of Pharmacy, Hangzhou Medical College, Hangzhou, China
| | - Wenwen Xie
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China
| | - Yu Jia
- Amgen Inc., Thousand Oaks, CA, USA
| | | | | | - Quanming Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness. Am J Prev Cardiol 2022; 12:100371. [PMID: 36124049 PMCID: PMC9482082 DOI: 10.1016/j.ajpc.2022.100371] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 12/12/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is epidemic throughout the world and is etiologic for such acute cardiovascular events as myocardial infarction, ischemic stroke, unstable angina, and death. ASCVD also impacts risk for dementia, chronic kidney disease peripheral arterial disease and mobility, impaired sexual response, and a host of other visceral impairments that adversely impact the quality and rate of progression of aging. The relationship between low-density lipoprotein cholesterol (LDL-C) and risk for ASCVD is one of the most highly established and investigated issues in the entirety of modern medicine. Elevated LDL-C is a necessary condition for atherogenesis induction. Basic scientific investigation, prospective longitudinal cohorts, and randomized clinical trials have all validated this association. Yet despite the enormous number of clinical trials which support the need for reducing the burden of atherogenic lipoprotein in blood, the percentage of high and very high-risk patients who achieve risk stratified LDL-C target reductions is low and has remained low for the last thirty years. Atherosclerosis is a preventable disease. As clinicians, the time has come for us to take primordial and primary prevention more serously. Despite a plethora of therapeutic approaches, the large majority of patients at risk for ASCVD are poorly or inadequately treated, leaving them vulnerable to disease progression, acute cardiovascular events, and poor aging due to loss of function in multiple visceral organs. Herein we discuss the need to greatly intensify efforts to reduce risk, decrease disease burden, and provide more comprehensive and earlier risk assessment to optimally prevent ASCVD and its complications. Evidence is presented to support that treatment should aim for far lower goals in cholesterol management, should take into account many more factors than commonly employed today and should begin significantly earlier in life.
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Huang G, Lu H, Li M, Lv Q, Chen Q. Association of total cholesterol and atherosclerotic cardiovascular disease in patients with follicular thyroid cancer: A real-world study from Chinese populations. Medicine (Baltimore) 2021; 100:e27310. [PMID: 34596129 PMCID: PMC8483838 DOI: 10.1097/md.0000000000027310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 08/18/2021] [Accepted: 09/06/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The association between serum total cholesterol (TC) level and incident atherosclerotic cardiovascular disease (ASCVD) in patients with follicular thyroid cancer postthyroidectomy is unknown.This was a retrospective study and patients (n = 384) were divided into low and high TC groups according to the median TC level. Incidence of composite ASCVD (myocardial infarction, ischemic stroke, and cardiovascular death) was compared between these 2 groups and factors contributing to the association of TC and ASCVD were evaluated.Patients in the high TC group were older and more likely to have diabetes and have higher C-reactive protein level. After thyroidectomy, serum levels of free triiodothyronine and free thyroxine were lower while thyroid-stimulating hormone level was higher in the high TC group. 31.6% and 39.7% of patients developed hypothyroidism in the low and high TC groups (P < .05) postthyroidectomy. The incidence rate of composite ASCVD was higher in the high TC versus low TC groups, with incidence rate ratio of 1.69 (95% confidence interval [CI]: 1.07-2.69), which was mainly driven by a higher incidence rate of myocardial infarction in the high TC group (incidence rate ratio: 2.11 and 95% CI: 1.10-4.20). In unadjusted model, higher TC was associated with 73% higher risk of composite ASCVD. After adjustment for hypothyroidism, the association of higher TC and composite ASCVD was attenuated into insignificance, with hazard ratio of 0.92 and 95% CI: 0.81 to 1.34.Increased TC level was associated with composite ASCVD, which might be attributed to hypothyroidism postthyroidectomy. The use of levothyroxine might help to prevent hypercholestemia and reduce the incidence of ASCVD.
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Tadaki H, Ogawa N, Yamanaka M, Motohashi Y, Sasase T, Kawai T, Toriniwa Y, Fukuda S, Ogawa N, Harada K, Ohta T, Yamada T. JTP-109192, a novel G protein-coupled receptor 119 agonist, prevents atherosclerosis by improving hypercholesterolaemia in congenic spontaneously hyperlipidaemic mice. Clin Exp Pharmacol Physiol 2021; 48:381-388. [PMID: 33068442 DOI: 10.1111/1440-1681.13423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/25/2020] [Accepted: 10/14/2020] [Indexed: 01/05/2023]
Abstract
G protein-coupled receptor 119 (GPR119) expression in pancreatic β-cells and intestinal L-cells is a potential therapeutic target for the treatment of type 2 diabetes. Previously, we have reported that the GPR119 agonist JTP-109192 improves glucose metabolism with single and repeated administration. Conversely, overexpression of the Gpr119 gene reportedly regulates cholesterol transporter expression in animal models, and a natural GPR119 agonist, oleoylethanolamide (OEA), improves atherosclerosis. Therefore, improving dyslipidaemia is considered a possible feature of GPR119 agonists. In the present study, the lipid-lowering effect of JTP-109192 was examined in BALB/c background spontaneously hyperlipidaemic (SHL) mice with repeated administration, once daily for 12 weeks. On repeated administration, JTP-109192 revealed a cholesterol-lowering effect and improved atherosclerosis following histopathological examination. With further investigation, the cholesterol-lowering effect and subsequent antiatherosclerotic effect of JTP-109192 was attributed to changes in intestinal cholesterol metabolism gene expression. Based on these results, JTP-109192 represents a new potential antihypercholesterolaemic agent for the treatment of dyslipidaemia.
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Affiliation(s)
- Hironobu Tadaki
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Naoto Ogawa
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Masao Yamanaka
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Yu Motohashi
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Tomohiko Sasase
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Takashi Kawai
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Yasufumi Toriniwa
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Sumiaki Fukuda
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Nobuya Ogawa
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Kazuhito Harada
- Central Pharmaceutical Research Institute, Japan Tobacco Inc., Osaka, Japan
| | - Takeshi Ohta
- Laboratory of Animal Physiology and Functional Anatomy, Graduate School of Agriculture, Kyoto University, Kyoto, Japan
| | - Takahisa Yamada
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
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Annemans L, Stock JK, Chapman MJ. PCSK9 inhibition, atherosclerotic cardiovascular disease, and health economics: Challenges at the crossroads. J Clin Lipidol 2019; 13:714-720. [DOI: 10.1016/j.jacl.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022]
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Cost-effectiveness and Budget Impact of Treatment with Evolocumab Versus Statins and Ezetimibe for Hypercholesterolemia in Spain. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rec.2018.05.003 10.1016/j.rec.2018.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Olry de Labry Lima A, Gimeno Ballester V, Sierra Sánchez JF, Matas Hoces A, González-Outón J, Alegre del Rey EJ. Coste-efectividad e impacto presupuestario del tratamiento con evolocumab frente a estatinas y ezetimiba para la hipercolesterolemia en España. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Olry de Labry Lima A, Gimeno Ballester V, Sierra Sánchez JF, Matas Hoces A, González-Outón J, Alegre Del Rey EJ. Cost-effectiveness and Budget Impact of Treatment with Evolocumab Versus Statins and Ezetimibe for Hypercholesterolemia in Spain. ACTA ACUST UNITED AC 2018; 71:1027-1035. [PMID: 29937273 DOI: 10.1016/j.rec.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/21/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the cost-effectiveness ratio and budget impact of treatment with evolocumab (PCSK9 inhibitor) for patients in secondary prevention in the Spanish National Health System. METHODS A budget impact analysis, decision tree and Markov models were designed under the public health system perspective, based on the only study with morbidity and mortality data (FOURIER). The alternatives compared were evolocumab vs statins, and dual therapy with ezetimibe in 5% of the population. The measure of effectiveness used was the number of cardiovascular events avoided. Univariate and probabilistic sensitivity analyses were performed. RESULTS The average annual cost of patients receiving evolocumab was 11 134.78€ and 393.83€ for standard treatment (statins plus ezetimibe). The incremental cost-effectiveness ratio was > 600 000 € per avoided cardiovascular event for both assessed outcomes (first: cardiovascular death, myocardial infarction, stroke, and hospitalization due to unstable angina or coronary revascularization; second: includes the first 3 events). To perform the 10-year Markov model, the average cost of standard treatment was 13 948.45€ vs 471 417.37€ with evolocumab. Treatment with evolocumab for patients with familial hypercholesterolemia would cost between 3 and 6.1 million euros, assuming a difference of 2.5 and 5.1 million euros with the standard treatment (2017). This difference would be between 204.3 and 1364.7 million euros (2021) for those with nonfamiliar hypercholesterolemia (secondary prevention). CONCLUSIONS Treatment with evolocumab is associated with a lower frequency of cardiovascular events, but is inefficient for patients suitable to receive this drug in the Spanish National Health System.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Área de Gestión de Servicios y Profesionales de la Salud, Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
| | | | | | - Antonio Matas Hoces
- Centro Andaluz de Información del Medicamento (CADIME), Campus Universitario de Cartuja, Granada, Spain
| | - Julio González-Outón
- Servicio de Admisión, Documentación e Información Sanitaria, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
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Shah P. Economic Evaluation of the PCSK9 Inhibitors in Prevention of the Cardiovascular Diseases. Curr Cardiol Rep 2018; 20:51. [DOI: 10.1007/s11886-018-0993-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Hess GP, Natarajan P, Faridi KF, Fievitz A, Valsdottir L, Yeh RW. Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitor Therapy: Payer Approvals and Rejections, and Patient Characteristics for Successful Prescribing. Circulation 2017; 136:2210-2219. [PMID: 29084735 DOI: 10.1161/circulationaha.117.028430] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/08/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are a novel class of medications for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease requiring additional lipid lowering beyond dietary measures and statin use. Because of the drugs' high cost, rates of prescription approval by payers may be low. We aimed to identify payer approval and rejection rates for PCSK9i prescriptions and the potential factors influencing these rates. METHODS This is a retrospective, descriptive cohort study using nationwide pharmacy claims linked to electronic medical records from a nationwide data warehouse. The data set includes >220 million patients from all 50 states and all payer types with 5140 distinct health plans. PCSK9i prescriptions were submitted for 51 466 patients in the pharmacy data set. The main outcome was approval or rejection of PCSK9i prescription claims. Factors associated with approval and rejection of these medications in the United States were assessed. RESULTS Among patients who were prescribed a PCSK9i, 47.0% were approved for coverage by the payer. Variables that were associated with PCSK9i approval included age >65 years (P<0.01), history of atherosclerotic cardiovascular disease (P<0.01), prescription by a cardiologist or nonprimary care provider (P<0.01), statin intolerance (P=0.03), longer statin duration (P=0.01), and noncommercial payers (P<0.01). Higher low-density lipoprotein cholesterol levels were not associated with higher approval rates. Commercial third-party payers had the lowest approval rates (24.4%) and Medicare had the highest (60.9%). CONCLUSIONS Rates of approval for PCSK9i therapy are low, even for patients who appear to meet labeled indications. Although a combination of clinical characteristics increases the likelihood of approval, payer type is the most significant factor.
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Affiliation(s)
- Gregory P Hess
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Pradeep Natarajan
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Kamil F Faridi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Anna Fievitz
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Linda Valsdottir
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.)
| | - Robert W Yeh
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (G.P.H.). Scientific Studies & Projects, Symphony Health, Conshohocken, PA (G.P.H., A.F.). Center for Genomic Medicine and Cardiovascular Research Center, Massachusetts General Hospital, Boston (P.N.). Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA (P.N.). Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (K.F.F., L.V., R.W.Y.).
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Landmesser U, Chapman MJ, Stock JK, Amarenco P, Belch JJF, Borén J, Farnier M, Ference BA, Gielen S, Graham I, Grobbee DE, Hovingh GK, Lüscher TF, Piepoli MF, Ray KK, Stroes ES, Wiklund O, Windecker S, Zamorano JL, Pinto F, Tokgözoğlu L, Bax JJ, Catapano AL. 2017 Update of ESC/EAS Task Force on practical clinical guidance for proprotein convertase subtilisin/kexin type 9 inhibition in patients with atherosclerotic cardiovascular disease or in familial hypercholesterolaemia. Eur Heart J 2017; 39:1131-1143. [DOI: 10.1093/eurheartj/ehx549] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin Institute of Health (BIH), German Center of Cardiovascular Research (DZHK), Hindenburgdamm 30, 12203 Berlin, Germany
| | - M John Chapman
- National Institute for Health and Medical Research (INSERM), University of Pierre and Marie Curie, Pitié-Salpêtrière Hospital, Paris, France
| | - Jane K Stock
- European Atherosclerosis Society, Gothenburg, Sweden
| | - Pierre Amarenco
- Paris-Diderot-Sorbonne University and Department of Neurology and Stroke Centre, Bichat Hospital, Paris, France
| | - Jill J F Belch
- Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, UK
| | - Jan Borén
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, and Wallenberg Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michel Farnier
- Lipid Clinic, Point Medical, and Department of Cardiology, CHU Dijon-Bourgogne, Dijon, France
| | - Brian A Ference
- Division of Cardiovascular Medicine, Division of Translational Research and Clinical Epidemiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Stephan Gielen
- Department of Internal Medicine III, Martin-Luther-University Halle/Wittenberg, University Hospital, Halle/Saale, Germany
| | | | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas F Lüscher
- University Heart Center, Department of Cardiology, University Hospital Zurich, and Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, G Da Saliceto Hospital, Piacenza, Italy
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Erik S Stroes
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Olov Wiklund
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stephan Windecker
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, Bern, Switzerland
| | - Jose Luis Zamorano
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain
| | - Fausto Pinto
- Cardiology Department, CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and Multimedica IRCSS Milano, Italy
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Choi J, Khan AM, Jarmin M, Goldenberg N, Glueck CJ, Wang P. Efficacy and safety of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, alirocumab and evolocumab, a post-commercialization study. Lipids Health Dis 2017; 16:141. [PMID: 28738813 PMCID: PMC5525304 DOI: 10.1186/s12944-017-0493-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/22/2017] [Indexed: 01/29/2023] Open
Abstract
Background Efficacy-safety of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, alirocumab (ALI) and evolocumab (EVO), have previously been evaluated through controlled clinical trials with selective patient groups. Post-commercially, in 69 patients with heterozygous familial hypercholesterolemia (HeFH) and/or cardiovascular disease (CVD) with suboptimal LDL cholesterol (LDLC) lowering on maximal tolerated LDLC therapy, we assessed efficacy and safety of ALI and EVO. Methods Post-commercially, we started 29 patients on ALI 75 mg, 18 on ALI 150 mg, and 22 on EVO 140 mg every 2 weeks added to a maximally tolerated LDLC-lowering regimen. Since LDLC lowering did not differ between ALI 150 and EVO 140 mg, ALI 150-EVO 140 data were pooled (ALI-EVO). Changes in LDLC and AHA and NIH calculated 10-year CVD risks were assessed. Results Of the 69 patients, 25 had HeFH, 25 CVD, and 19 had both. At entry, 23 (33%) took statins and 46 (67%) were statin-intolerant. Mean ± SD and median follow-up were 49 ± 13 and 49 weeks on ALI 75 mg, and 37 ± 12 and 33 weeks on ALI-EVO. In the ALI-EVO group (n = 40), median LDLC fell from 165 mg/dl at entry to 70 mg/dl (median − 59%, p < .0001). AHA 10-year calculated CVD risk fell from 10.2 to 5.5% (median − 28%, p < .0001), and by the NIH calculator from 14.2 to 3.6% (median − 78%, p < .0001). In the ALI 75 mg group (n = 29), entry LDLC fell from 115 to 68 mg/dl (median − 39%, p < .0001). AHA 10-year calculated CVD risk fell from 11.5 to 7.3% (median − 20%, p = .004), and NIH 10-year risk from 12.9 to 5.1% (median 67%, p < .0001). Absolute and percent change in LDLC was independent of statin use. There were flu-like symptoms in 14% of patients. Adverse events did not differ (p > 0.05) between ALI 75 mg and ALI-EVO. Conclusion In patients with HeFH and/or CVD, LDLC decreased from 115 to 68 mg/dl (39%) on ALI 75 mg with mean follow-up of 49 weeks, and from 165 to 70 mg/dl (59%) on ALI-EVO over 37 weeks, p < .0001 for both. Adverse events were minimal and tolerable. ALI and EVO represent paradigm shifts in LDLC lowering.
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Affiliation(s)
- Joshua Choi
- Graduate Medical Education and Research, The Jewish Hospital- Mercy Health, Graduate Medical Education and Research, Cincinnati, USA
| | - Amir M Khan
- Graduate Medical Education and Research, The Jewish Hospital- Mercy Health, Graduate Medical Education and Research, Cincinnati, USA.
| | - Michael Jarmin
- Graduate Medical Education and Research, The Jewish Hospital- Mercy Health, Graduate Medical Education and Research, Cincinnati, USA
| | - Naila Goldenberg
- Graduate Medical Education and Research, The Jewish Hospital- Mercy Health, Graduate Medical Education and Research, Cincinnati, USA
| | - Charles J Glueck
- Graduate Medical Education and Research, The Jewish Hospital- Mercy Health, Graduate Medical Education and Research, Cincinnati, USA
| | - Ping Wang
- Graduate Medical Education and Research, The Jewish Hospital- Mercy Health, Graduate Medical Education and Research, Cincinnati, USA
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Abstract
INTRODUCTION Cardiovascular morbidity and mortality are of increasing concern, not only to patients but also to the health care profession and service providers. The preventative benefit of treatment of dyslipidaemia is unquestioned but there is a large, so far unmet need to improve clinical outcome. There are exciting new discoveries of targets that may translate into improved clinical outcome. Areas covered: This review highlights some new pathways in cholesterol and triglyceride metabolism and examines new targets, new drugs and new molecules. The review includes the results of recent trials of relatively new drugs that have shown benefit in cardiovascular endpoint outcomes, drugs that have been licenced without endpoint trials yet available and new drugs that have not yet been licenced but have produced exciting results in animal studies and some in early phase 2 human studies. Expert opinion: The new areas that have been discovered as the cause of dyslipidaemia have opened up a host of new targets for new drugs including antisense RNA's, microRNA's and human monoclonal antibodies. The plethora of new targets and new drugs has made it an extraordinarily exciting time in the development of therapeutics to combat atherosclerosis.
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Affiliation(s)
- Gerald H Tomkin
- a Diabetes Institute of Ireland , Beacon Clinic and Trinity College , Dublin 2 , Ireland
| | - Daphne Owens
- a Diabetes Institute of Ireland , Beacon Clinic and Trinity College , Dublin 2 , Ireland
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Pyles LA, Elliott E, Neal WA. Screening for Hypercholesterolemia in Children: What Strategies Can Be Employed. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0531-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shah P, Glueck CJ, Goldenberg N, Min S, Mahida C, Schlam I, Rothschild M, Huda A, Wang P. Efficacy, safety, Low density lipoprotein cholesterol lowering, and calculated 10-year cardiovascular risk reduction of alirocumab and evolocumab in addition to maximal tolerated cholesterol lowering therapy: a post-commercialization study. Lipids Health Dis 2017; 16:19. [PMID: 28115017 PMCID: PMC5259842 DOI: 10.1186/s12944-017-0416-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background Efficacy and safety of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, alirocumab (ALI) and evolocumab (EVO) have previously been evaluated through controlled clinical trials with selective patient groups. Post-commercially, in patients with heterozygous familial hypercholesterolemia (HeFH) and/or cardiovascular disease (CVD) with suboptimal LDL cholesterol (LDLC) lowering on maximal tolerated cholesterol lowering therapy, we assessed efficacy and safety of ALI and EVO. Methods Post-commercially, we started 25 patients on ALI 75 mg, 15 on ALI 150 mg, and 32 on EVO 140 mg bi-weekly added to entry LDLC lowering regimen, with follow-up for a median 24 weeks. History, physical exam, demographics, and adverse event data were collected. Changes in LDLC and AHA and NIH calculated 10-year CVD risks were assessed on ALI and EVO. Results Of 72 patients, 25 had HeFH only, 25 CVD only, 22 had both, median age was 65 years, 63% females, 38% males, 86% Caucasian, 11% African-Americans, 17% diabetics, 63% on anti-hypertensives, and 7% smokers. At entry, 30 (42%) were on a statin and 42 (58%) could not tolerate any statins. At 24-weeks, median LDLC decreased on ALI 75 mg from 117 to 62 mg/dL (−54%), on ALI 150 mg from 175 to 57 mg/dL (−63%), and on EVO 140 mg from 165 to 69 mg/dL (−63%), p <0.0001 for all. Absolute and percent LDLC reduction did not differ (p >.05) between ALI 150 and EVO 140 mg, but were less on ALI 75 mg vs ALI 150 mg and EVO 140 mg (p <.05). Percent reductions in 10-year CVD risks by AHA and NIH calculators, respectively were ALI 75 mg −22 and −44%, ALI 150 mg −31 and −50%, and EVO 140 mg −29 and −56%, p ≤.002 for all. The three most common adverse events included flu-like myositis 10%, respiratory tract symptoms 8%, and injection site reaction 6%. Conclusion In patients with HeFH and/or CVD, LDLC was lowered by 63% on EVO and ALI 150 mg, and 54% on ALI 75 mg. Adverse events were minimal and tolerable. ALI and EVO represent paradigm shifts in LDLC lowering. Long term, post-commercial safety and efficacy remain to be determined.
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Affiliation(s)
- Parth Shah
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
| | - Charles J Glueck
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA
| | - Naila Goldenberg
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA
| | - Sarah Min
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Chris Mahida
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Ilana Schlam
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Matan Rothschild
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Ali Huda
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Ping Wang
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA
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