Efficacy and Safety of Alirocumab and Evolocumab as Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors in Familial Hypercholesterolemia: A Systematic Review and Meta-Analysis


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Abstract

Background:Familial hypercholesterolemia (FH) is a prevalent and potentially fatal illness that causes a substantial elevation in low-density lipoprotein cholesterol (LDL-C).

Methods:A comprehensive search was done on PubMed/MEDLINE, EMBASE, Web of Science (WOS/ ISI), Scopus, ClinicalTrials (www.ClinicalTrials.gov), and conferences/ congress research papers. Random effect models were used to calculate mean differences (%) and risk ratios (RRs), and confidence intervals (95%).

Results:Ten studies (n=1489 patients) were included in this study. PCSK9 inhibitors decreased the levels of LDL-C by -49.59% (95%CI -55.5%, -43.67%) as compared to placebo. They also didn’t alter the Treatment-Emergent Adverse Event (TEAE) and neuronal events by RR 0.92 (0.75, 1.13) and 1.31 (0.66, 2.59), respectively. PCSK9 inhibitors were effective and safe in treating patients with FH.

Conclusion:There was high-quality evidence showing that monoclonal antibodies (alirocumab & evolocumab) lower LDL-C (GRADE: high), lipoprotein (a) (GRADE: High), triglycerides (TG) (GRADE: High), total cholesterol (GRADE: High), non-high-density lipoprotein cholesterol (non- HDL-C) (GRADE: Moderate), and apolipoprotein B (GRADE: High), and increase the HDL-C (GRADE: High) as well as apolipoprotein A1 (GRADE: High). Comparing PCSK9 inhibitors against placebo, neither TEAE (GRADE: high) nor neuronal events (GRADE: moderate) were changed.

Registration number:PROSPERO-CRD42022334035

About the authors

Ghasem Ghasempour

Davee Department of Neurology, Feinberg School of Medicine,, Northwestern University

Email: info@benthamscience.net

Fahimeh Zamani-Garmsiri

Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences

Email: info@benthamscience.net

Farhad Shaikhnia

Department of Clinical Biochemistry, Faculty of Medicine, Uraemia University of Medical Sciences,

Email: info@benthamscience.net

Ali Soleimani

Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences

Email: info@benthamscience.net

Syed Reza Hosseini Fard

Department of Clinical Biochemistry, Faculty of Medicine,, Tehran University of Medical Sciences

Email: info@benthamscience.net

Janani Leila

Department of Biostatistics, School of Public Health, Iran University of Medical Sciences

Email: info@benthamscience.net

Shohreh Teimuri

Institute of Cell Biology, University of Bern

Email: info@benthamscience.net

Najmeh Parvaz

Department of Clinical Biochemistry, School of Medicine,, Iran University of Medical Sciences

Email: info@benthamscience.net

Payam Mohammadi

Davee Department of Neurology, Feinberg School of Medicine, Northwestern University,

Email: info@benthamscience.net

Mohammad Najafi

Department of Clinical Biochemistry, School of Medicine, Iran University of Medical Sciences

Author for correspondence.
Email: info@benthamscience.net

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