Interv Akut Kardiol. 2018;17(4):212-217 | DOI: 10.36290/kar.2018.057

Treating hypercholesterolaemia with evolocumab

Richard Češka, Michaela Šnejdrlová, Michal Vrablík, Tereza Altschmiedová, Tomáš Štulc

Centrum preventivní kardiologie, III. interní klinika 1. LF UK a VFN, Praha

Cardiovascular diseases (CVDs) still remain a crucial problem for all western countries as well as for those countries that followtheir pattern of economic development. Even though the treatment of CVDs has gone through enormous success in recentyears, risk factor control is of no less (or even more) importance. Among risk factors, LDL-C plays an essential role as a primarygoal of treatment. Nonpharmacological measures with an emphasis on lifestyle modification are the mainstay of treatment. Ina high proportion of patients, however, pharmacological treatment must be used. Statin therapy is a cornerstone in treatment,with ezetimib being added in combination therapy to reduce LDL-C. PCSK9 inhibitors represent a new class of drugs that, in adramatic way, positively affect the lipid profile (particularly LDL-C, but also apo B and Lp/a/). These lipid effects have been veryclosely studied in a number of trials in the past few years. Further studies then investigated the safety profile. All these studieshave brought positive results only. Moreover, in the last year, large trials (megatrials of tens of thousands of patients) have beenpublished that studied the effects of treatment with PCSK9 inhibitors on CV morbidity and mortality. These trials, the FOURIERand ODDYSEY outcomes, then showed not only a reduction in CV risk and CV episodes, but also a reduction in overall mortality.The present paper deals mainly with the experience and outcomes that have been obtained with evolocumab, available underthe brand name Repatha. The outcomes of trials are discussed, with a particular focus on the FOURIER trial and the safety analysesthat addressed, among other things, neurocognitive functions (the Ebbinghaus trial) or the development of new diabetes mellitus(DM) that, unlike with statins, was not observed. Attention is also paid to selected subgroups of patients treated with PCSK9inhibitors (with a positive effect mostly), e.g. patients with familial hypercholesterolaemia (FH) or those with DM.

Keywords: evolocumab, Repatha, hypercholesterolaemia, FOURIER, Ebbinghaus, diabetes mellitus, statins, ezetimib

Published: December 1, 2018  Show citation