Study: Evolocumab Shows a Higher Reduction in LDL-C Than Alirocumab

Alirocumab (Praluent) has reduced effectiveness compared with evolocumab (Repatha) for individuals with hypercholesterolemia who do not attain low-density lipoprotein cholesterol (LDL-C) and/or are intolerant to other lipid-lowering drugs, results of a study published in Biomedicine & Pharmacotherapy showed.

Investigators found that there was about a 59.9% reduction in LDL-C during treatment with PCSK9 inhibitors where adverse events (AEs) were manageable and mild.

Smaller LDL-C reductions were related to an absence of concomitant lipid-lowering therapy, being female, and treatment with alirocumab. The LDL-C reduction differences between alirocumab and evolocumab rose globally to 9% after investigators adjusted for confounders.

In previous clinical studies and meta-analyses, the results suggested that alirocumab reduces LDL-C less than evolocumab, with the absolute differences varying by 10% to 20%, depending on the study.

Investigators also said that the variation in potency could contribute to the number of individuals who were talking the maximum allowed dosage of 150 mg.

However, in another meta-analysis, investigators observed no difference between alirocumab 75 mg and 150 mg.

At week 4, there was about a 61.6% reduction in the evolocumab group and a 51.7% reduction in the alirocumab group. At week 12, there were 62.1% and 49.2% reductions, respectfully.

Additionally at week 24, there was a 63.9% reduction and a 47.7% reduction, and at week 120, there were 63.3% and 55.4% reductions, respectively.

At no point was the reduction from alirocumab greater that the reduction with evolocumab.

The study included 115 individuals who received wither alirocumab or evolocumab in a hospital setting between February 2017 and April 2020.

The median of the follow-up was 20.4 months. Additionally, the main outcomes recorded were drug-related AEs, the incidence of major cardiovascular events, the percentage of individuals achieving therapeutic goals, and the relative reduction in LDL-C.

The individuals included in the study were from a hospital in Spain. All individuals initiated a treatment with alirocumab 75 mg, which could be adjusted to 150 mg or evolocumab 140 mg once every 2 weeks.

At the initial visit, baseline lipid data, such as high-density lipoprotein cholesterol (HDL-C), LDL-C, non-HDL-C, total cholesterol, and triglycerides, and demographic data, such as age, cardiovascular history, comorbidities, concomitant anti-lipidic therapy, lifestyle, and sex, were collected using a defined questionnaire.

Individuals followed a schedule of visits with their providers and pharmacists at months 1, 2, 3, 6, 9, 12, 15, 18, 24, and 30. During the visits, the effectiveness and safety were reviewed, as were changes in therapy and drug-related AEs.

Individuals who switched drugs participated in the follow-up, which was an independent study of effectiveness and safety.

Investigators concluded that it is important to study the potency of the drugs further.

They acknowledged that their pool of individuals was limited, because it was a single-center study.

Reference

Vicente-Valor J, García-González X, Ibáñez-García S, et al. PCSK9 inhibitors revisited: effectiveness and safety of PCSK9 inhibitors in a real-life Spanish cohort. Biomed Pharmacother. 2022;146:112519. doi:10.1016/j.biopha.2021.112519