Author + information
- Sarah Min, MD,
- Naila Goldenberg, MD,
- Charles Glueck, MD and
- Ping Wang, PhD
In 107 high-risk patients, 60% with cardiovascular disease (CVD), and with median low-density lipoprotein cholesterol (LDLC) 149 mg/dL despite maximum tolerated lipid lowering therapy (MTLT), we compared and contrasted efficacy-safety of Alirocumab (ALI 75mg, 150 mg) and Evolocumab (EVO 140 mg).
We followed 107 patients for a median 24 weeks, 33 on ALI 75 mg, 30 on ALI 150 mg, and 44 on EVO 140 mg bi-weekly. After adjustment for age, race, gender, body mass index, treatment duration, entry LDLC, heterozygous familial hypercholesterolemia (+/-), statin intolerance (+/-), and previous CVD (+/), absolute and % changes in LDLC were compared for the ALI and EVO doses. Treatment side effects were also compared.
Of the 107 patients, 70 could not tolerate any statin. LDLC reduction from baseline MTLT was 45% for ALI 75 mg, 64% for ALI 150 mg, and 63% for EVO 140 mg (p<0.0001 for all). Absolute and % LDLC lowering was greater on ALI 150 mg than 75 mg (p=0.0013, p=0.0018), and greater on EVO 140 mg than ALI 75 mg (p=0.017, p=0.005). No differences were observed between any groups for treatment-associated side effects (p>0.05).
EVO 140 mg and ALI 150 mg did not differ in LDLC reduction, however ALI 75 mg had lower absolute and % LDLC reduction than ALI 150 mg or EVO 140 mg. Side effect profiles did not differ. All 3 groups represent paradigm shifts in LDLC lowering, particularly for patients with statin intolerance who comprised 65% of our 107 high-risk hypercholesterolemic patients.