Chairs: A. Vogt (Munich, Germany), R. Klingel (Cologne, Germany)
|PCSK9-therapy in patients undergoing lipoprotein apheresis
1 Klinikum der Universität München, Medizinische Klinik IV - Grosshadern, München, Germany
Abstract text :
PCSK9-inhibition and lipoprotein-apheresis (LA) are both treatment modalities to reduce LDL-cholesterol. For many years LA has been the therapy of last resort in patients non-responsive, not reaching goals on or intolerant to statins in combination with ezetimibe and other lipid lowering medications. Since 2015 PCSK9-inhibitors are available as an alternative medication which can further reduce LDL-cholesterol and which is tolerated by most patients intolerant to statins. In the ODYSSEY Escape trial alirocumab was evaluated in patients with heterozygous familial hypercholesterolemia treated by regular LA. It was shown that on average lower LDL-cholesterol levels can be achieved by alirocumab and that the vast majority of apheresis can be omitted if an arbitrary cut-off value of 30% LDL-reduction is used. Similar data are available for evolocumab in patients with severe hypercholesterolemia (one published study in Japanese patients and one preliminary published international study) again showing that LDL-cholesterol reduction is more pronounced with PCSK9-inhibition than with apheresis. Taken together, these data show that in many patients requiring LA so far treatment goals can be reached with PCSK9 inhibition. Finally it was also shown that some patients with homozygous familial hypercholesterolemia requiring LA may also benefit from additional PCSK9-inhibition. The available data indicate that PCSK9-inhibition with alirocumab or evolocumab is less expensive, less time consuming, less invasive, and more effective in reducing LDL-cholesterol than LA. Apheresis should therefore be reserved to subjects not achieving LDL-cholesterol goals or intolerant to a maximally tolerated combination of statins, ezetimibe and PCSK9-inhibition.