Abstract
Prevention of cardiovascular diseases (CVDs) has been an insurmountable challenge for a clinician. The prevalence of CVDs has been consistently increasing. There is indisputable evidence that Low Density Lipoprotein cholesterol (LDLc) is a principal driver of ASCVD thus LDLc reduction is important to reduce risk of CVDs. LDLc reduction is critically related to improved plaque stability and reduction of atheroma volume. Low Density Lipoprotein cholesterol (LDLc), the primary driver of atherosclerosisis, is the key target for intervention for prevention of CVDs. Yet, despite best treatment by statins which are the first line drugs for the treatment of dyslipidemia, inadequate LDLc reduction can be problematic in high risk patients. PCSK9 antibody, alirocumab was approved by Food and Drug Administration (FDA) in 2015. The addition of alirocumab to statin or any other lipid lowering drug results in clinically significant as well as sustained LDLc reduction with fewer side effects in patients with suboptimal LDLc lowering. Thus, Based on its novel mechanism of action, aliorcumab can be very instrumental for filling the lacuna in the treatment of dyslipidemia.
Keywords: Alirocumab, Low-density Lipoprotein Cholesterol, Proprotein Convertase Subtilisin/Kexin type 9, PCSK9 inhibitors.
References
- Keenan NL, Shaw KM. Coronary heart disease and stroke deaths - United States, 2006. MMWR Suppl. 2011;60(1):62–6.
- Wadhera RK, Steen DL, Khan I, Giugliano RP, Foody JM. A review of low-density lipoprotein cholesterol, treatment strategies, and its impact on cardiovascular disease morbidity and mortality. May–June, 2016,10(3), 472–89.
- Chapman MJ, Stock JK, Ginsberg HN. PCSK9 inhibitors and cardiovascular disease: heralding a new therapeutic era. Curr Opin Lipidol.2015Dec;26(6):511-20.
- Fitzgerald K, White S, Borodovsky A, Bettencourt BR, et al. A highly durable RNAi therapeutic inhibitor of PCSK9. New England Journal of Medicine. 2017 Jan 5;376(1):41-51.
- Ridker PM, Tardif JC, Amarenco P, Duggan W, Glynn RJ, Jukema JW, Kastelein JJ, Kim AM, Koenig W, Nissen S, Revkin J. Lipid-reduction variability and antidrug-antibody formation with bococizumab. New England Journal of Medicine. 2017 Apr 20;376(16):1517-26.
- Lagace TA, Curtis DE, Garuti R, et al. Secreted PCSK9 decreases the number of LDL receptors in hepatocytes and in livers of parabiotic mice. J Clin Invest.2006 Nov;116(11):2995-3005.
- Leren TP. Sorting an LDL receptor with bound PCSK9 to intracellular degradation. 2014 Nov;237(1):76-81.
- Lagace TA. PCSK9 and LDLR degradation: regulatory mechanisms in circulation and in cells. Curr Opin Lipidol. 2014 Oct; 25(5): 387–93
- Cecilia C. Low Wang, Connie N. Hess, William R. Hiatt, Allison B. Goldfine. Clinical Update: Cardiovascular Disease in Diabetes Mellitus.Circulation. 2016 June;133(24):2459-2502.
- Stein EA, Gipe D, Bergeron J, et al. Effect of a monoclonal antibody to PCSK9, REGN727/SAR236553, to reduce low-density lipoprotein cholesterol in patients with heterozygous familial hypercholesterolaemia on stable statin dose with or without ezetimibe therapy: a phase 2 randomised controlled trial. 2012 Jul 7;380(9836):29-36.
- Roth EM, McKenny JM, Hanotin C, Asset G, Stein EA. Atorvastatin with or without an antibody to PCSK9 in primary hypercholesterolemia. N Engl J Med.2012 Nov 15;367(20):1891-900
- McKenney JM, Koren MJ, Keveiakes DJ, Flanotin C, Ferrand XC, Stein EA. Safety and efficacy of a monoclonal antibody to proprotein convertase subtilisin/Kexin type 9 serine protease SAR 236553/REG 727 in patients with primary hypercholesterolemia receiving ongoing stable atorvastatin therapy. J Am Coll Cardiol.2012 Jun 19;59(25):2344-53.
- Sabatine MS1, Giugliano RP, Wiviott SD, Raal FJ, Blom DJ, et al; Open-Label Study of Long-Term Evaluation against LDL Cholesterol (OSLER) Investigators. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events. N Engl J Med.2015 Apr 16;372(16):1500-9.
- Roth EM, McKenney JM. ODYSSEY MONO: effect of alirocumab 75 mg subcutaneously every 2 weeks as monotherapy versus ezetimibe over 24 weeks. Future Cardiology, 2015 Jan.,11 (1): 27-37.
- Cannon CP, Cariou B, Blom D, McKenney JM, Lorenzato C, Pordy R, Chaudhari U, Colhoun HM; for the ODYSSEY COMBO II Investigators. Efficacy and safety of alirocumab in high cardiovascular risk patients with inadequately controlled hypercholest-erolaemia on maximally tolerated doses of statins: the ODYSSEY COMBO II randomized controlled trial. Eur Heart J. 2015;36:1186–1194.
- Robinson JG, Farnier M, Krempf M, Bergeron J, Luc G, Averna M, Stroes ES, Langslet G, Raal FJ, El Shahawy M, Koren MJ, Lepor NE, Lorenzato C, Pordy R, Chaudhari U, Kastelein JJ and Investigators OLT. Efficacy and safety of Alirocumab in reducing lipids and cardiovascular events. N Engl J Med. 2015;372:1489-99.
- Moriarty PM, Thompson PD, Cannon CP, et al. Efficacy and safety of alirocumab vs ezetimibe in statin-intolerant patients, with a statin rechallenge arm: The ODYSSEY ALTERNATIVE randomized trial. J Clin Lipidol 2015.
- Bays H, Gaudet D et al. Alirocumab as Add-On to Atorvastatin Versus Other Lipid Treatment Strategies: ODYSSEY OPTIONS I Randomized Trial. J Clin Endocrinol Metab. 2015 Aug;100(8):3140-8. doi: 10.1210/jc.2015-1520.
- Farnier M1, Jones P. Efficacy and safety of adding alirocumab to rosuvastatin versus adding ezetimibe or doubling the rosuvastatin dose in high cardiovascular-risk patients: The Odyssey Options II randomized trial. Atherosclerosis. 2016 Jan;244:138-46. doi: 10.1016/j.atherosclerosis.2015.11.010. Epub 2015 Nov 14.
- Kastelein JJ, Ginsberg HN, Langslet G, et al. ODYSSEY FH I and FH II: 78 & week results with alirocumab treatment in 735 patients with heterozygous familial hypercholesterolaemia. Eur Heart J 2015 Nov 14;36(43):2996-3003.
- Erik Stroes, John R. Guyton, Norman Lepor et al. Efficacy and Safety of Alirocumab 150 mg Every 4 Weeks in Patients With Hypercholesterolemia Not on Statin Therapy: The Odyssey Choice II Study. Journal of the American Heart Association. 2016;5:e003421 https://doi.org/10.1161/JAHA.116.003421
- Roth EM1, Moriarty PM. A phase III randomized trial evaluating alirocumab 300 mg every 4 weeks as monotherapy or add-on to statin: ODYSSEY CHOICE I. Atherosclerosis. 2016 Nov;254:254-262. doi: 10.1016/j.atherosclerosis.2016.08. 043. Epub 2016 Aug 31.
- Patrick M. Moriarty Klaus G. Parhofer et al. Alirocumab in patients with heterozy-gous familial hypercholesterolaemia undergoing lipoprotein apheresis: the ODYSSEY ESCAPE trial. Eur Heart J (2016) 37 (48): 3588-3595. DOI: https://doi.org/10.1093/eurheartj/ehw388
- Ginsberg HN, Rader DJ, Raal FJ, et al. ODYSSEY HIGH FH: efficacy and safety of alirocumab in patients with severe heterozygous familial hypercholesterol-emia [abstract]. Circulation 2014; 130:2119.
- Parth Shah et al. 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 in Health and Disease 2017; 16:19 DOI: 10.1186/s12944-017-0416-7
- Schwartz GG, Bessac L, et al. Effect of alirocumab, a monoclonal antibody to PCSK9, on long-term cardiovascular outcomes following acute coronary syndromes: rationale and design of the ODYSSEY outcomes trial. Am Heart J. 2014 Nov;168(5):682-9. doi: 10.1016/j.ahj.2014.07.028. Epub 2014 Aug 7. https://clinicaltrials.gov/ct2/show/-NCT01663402.
- G. Seidah, Z. Awan, M. Chretien, et al. PCSK9: a key modulator of cardio- vascular health, Circ. Res. 114 (2014) 1022e1036.
- L. Guo, J. Liu, R.X. Xu, et al. Short-term impact of low-dose atorvastatin on serum proprotein convertase subtilisin/ kexin type 9, Clin. Drug Investig. 33 (2013) 877e883.
- Ioanna Gouni-Berthold, Heiner K. Berthold. PCSK9 Antibodies for the Treatment of Hypercholesterolemia. Nutrients. 2014 Dec; 6(12): 5517–5533. doi: 3390/nu6125517
- Cryer PE, Davis SN. Disorders of Lipoprotein Metabolism. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill; 2015.2435-49.
- Julius U. Lipoprotein apheresis in the management of severe hypercholestero-lemia and of elevation of lipoprotein(a): current perspectives and patient selection. Med Devices (Auckl).2016 Oct 13;9:349-360.
- Rosada A, Kassner U, Banisch D, Bender A, Steinhagen-Thiessen E, Vogt A. Quality of life in patients treated with lipoprotein apheresis. J Clin Lipidol. 2016;10(2):323–329.
- Michael J. Koren et al. Effect of PCSK9 Inhibition by Alirocumab on Lipoprotein Particle Concentrations Determined by Nuclear Magnetic Resonance Spectro-scopy. J Am Heart Assoc.2015Nov; 4(11).
- Gupta, S. Development of proprotein convertase subtilisin/kexin type 9 inhibitors and the clinical potential of monoclonal antibodies in the management of lipid disorders. Vascular Health and Risk Management. November 2016 Volume 2016:12 Pages 421—433. http://doi.org/10.2147/VHRM.S83719
Corresponding Author
Dr Ajay Shukla
Asst. Professor, Dept of Pharmacology, AIIMS Bhopal INDIA
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