PMID- 37335067 OWN - NLM STAT- MEDLINE DCOM- 20230912 LR - 20230912 IS - 2299-8306 (Electronic) IS - 0423-104X (Linking) VI - 74 IP - 3 DP - 2023 TI - Impact of alirocumab/evolocumab on lipoprotein (a) concentrations in patients with familial hypercholesterolaemia: a systematic review and meta-analysis of randomized controlled trials. PG - 234-242 LID - 10.5603/EP.a2023.0036 [doi] AB - INTRODUCTION: Familial hypercholesterolaemia (FH) is a common hereditary genetic disorder, characterized by elevated circulating low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] concentrations, leading to atherosclerotic cardiovascular disease (ASCVD). Two types of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors- alirocumab and evolocumab- are efficient drugs in the treatment of FH, which can effectively reduce Lp(a) levels. MATERIAL AND METHODS: Embase, MEDLINE, and PubMed up to November 2022 were searched for randomized clinical trials (RCTs) evaluating the effect of alirocumab/evolocumab and placebo treatment on plasma Lp(a) levels in FH. Statistics were analysed by Review Manager (RevMan 5.3) and Stata 15.1. RESULTS: Eleven RCTs involved a total of 2408 participants. Alirocumab/evolocumab showed a significant efficacy in reducing Lp(a) [weighted mean difference (WMD): -20.10%, 95% confidence interval (CI): -25.59% to -14.61%] compared with placebo. In the drug type subgroup analyses, although the efficacy of evolocumab was slightly low (WMD: -19.98%, 95% CI: -25.23% to -14.73%), there was no difference with alirocumab (WMD: -20.54%, 95% CI: -30.07% to -11.02%). In the treatment duration subgroup analyses, the efficacy of the 12-week duration group (WMD: -17.61%, 95% CI: -23.84% to -11.38%) was lower than in the group of >/= 24 weeks' duration (WMD: -22.81%, 95% CI: -31.56% to -14.07%). In the participants' characteristics subgroup analyses, the results showed that no differential effect of alirocumab/evolocumab therapy on plasma Lp(a) concentrations was observed (heterozygous FH [HeFH] WMD: -20.07%, 95% CI: -26.07% to -14.08%; homozygous FH [HoFH] WMD: -20.04%, 95% CI: -36.31% to -3.77%). Evaluation of all-cause adverse events (AEs) between alirocumab/evolocumab groups and placebo groups [relative risk (RR): 1.05, 95% CI: 0.98-1.12] implied no obvious difference between the 2 groups. CONCLUSIONS: Anti-PCSK9 drugs (alirocumab and evolocumab) may be effective as therapy for reducing serum Lp(a) levels in FH, and no differences were observed in treatment durations, participant characteristics, and other aspects of the 2 types of PCSk9 inhibitors. However, further experimental studies and RCTs are warranted to clarify the mechanism of PSCK9 inhibitors to lowering Lp(a) concentrations in FH. FAU - Dai, Haibing AU - Dai H AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. 2832845671@qq.com. AD - College of Laboratory Medicine, Zunyi Medical University, Zunyi, China. 2832845671@qq.com. FAU - Zhu, Yonglin AU - Zhu Y AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. AD - College of Laboratory Medicine, Zunyi Medical University, Zunyi, China. FAU - Chen, Zuyi AU - Chen Z AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. AD - College of Laboratory Medicine, Zunyi Medical University, Zunyi, China. FAU - Yan, Renqing AU - Yan R AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. AD - College of Laboratory Medicine, Zunyi Medical University, Zunyi, China. FAU - Liu, Jinsong AU - Liu J AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. AD - College of Laboratory Medicine, Zunyi Medical University, Zunyi, China. FAU - He, Ziyun AU - He Z AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. AD - College of Laboratory Medicine, Zunyi Medical University, Zunyi, China. FAU - Zhang, Lin AU - Zhang L AD - School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Zhang, Feng AU - Zhang F AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. AD - College of Laboratory Medicine, Zunyi Medical University, Zunyi, China. FAU - Yan, Shengkai AU - Yan S AD - Department of Laboratory Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20230619 PL - Poland TA - Endokrynol Pol JT - Endokrynologia Polska JID - 0370674 RN - LKC0U3A8NJ (evolocumab) RN - PP0SHH6V16 (alirocumab) RN - 0 (Antibodies, Monoclonal) RN - 0 (Lipoprotein(a)) RN - 0 (Anticholesteremic Agents) SB - IM MH - Humans MH - Antibodies, Monoclonal/pharmacology/therapeutic use MH - Lipoprotein(a)/therapeutic use MH - Randomized Controlled Trials as Topic MH - *Hyperlipoproteinemia Type II/drug therapy MH - *Anticholesteremic Agents/pharmacology/therapeutic use OTO - NOTNLM OT - PCSK9 inhibitors OT - atherosclerotic cardiovascular disease OT - familial hypercholesterolaemia OT - lipoprotein (a) OT - meta-analysis OT - randomized controlled trials EDAT- 2023/06/19 13:08 MHDA- 2023/09/12 06:41 CRDT- 2023/06/19 08:34 PHST- 2022/10/07 00:00 [received] PHST- 2023/04/02 00:00 [accepted] PHST- 2022/12/17 00:00 [revised] PHST- 2023/09/12 06:41 [medline] PHST- 2023/06/19 13:08 [pubmed] PHST- 2023/06/19 08:34 [entrez] AID - VM/OJS/J/92198 [pii] AID - 10.5603/EP.a2023.0036 [doi] PST - ppublish SO - Endokrynol Pol. 2023;74(3):234-242. doi: 10.5603/EP.a2023.0036. Epub 2023 Jun 19.