A large Italian cohort on proprotein convertase subtilisin/kexin type 9 inhibitors

PCSK9 Inhibitors in a German Single-Center Clinical Practice: Real-World Treatment of Patients at High Cardiovascular Risk Over 68 Weeks

“…In an outpatient clinic in the Netherlands, approximately 17 months of treatment with either alirocumab or evolocumab resulted in a mean LDL-C reduction of 55% from baseline (4.4 mmol/L [170.1 mg/dL]) in a cohort of 238 patients, with similar reductions being observed across alirocumab (75 mg Q2W or 150 mg Q2W) and evolocumab dose regimens (140 mg Q2W or 420 mg monthly) [ 13 ]. In a retrospective study ( n = 122) in Italy, a mean LDL-C reduction of 52% from baseline (4.5 mmol/L [174 mg/dL]) was observed after approximately 13 months of treatment with either alirocumab or evolocumab, with no difference between drug regimens [ 27 ].…”

Inclisiran and lipoprotein apheresis in statin intolerance heterozygous FH patients: A case series

“…Dear Editor, In Familial Hypercholesterolemia (FH), statins treatment is the first choice to lower LDL cholesterol and to reduce cardiovascular morbidity and mortality, however, up to 10% of patients treated with statins report intolerance [1]. Monoclonal antibodies against Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (mAb PCSK9i) could be administered to lower LDL cholesterol in patients with muscle-related adverse events, but intolerance to mAb PCSK9i has also been described [2]. Within this context, Lipoprotein Apheresis (LA) still holds a valuable role, even in the new era of Lipid-Lowering Therapy (LLT) [2].…”

“…Monoclonal antibodies against Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (mAb PCSK9i) could be administered to lower LDL cholesterol in patients with muscle-related adverse events, but intolerance to mAb PCSK9i has also been described [2]. Within this context, Lipoprotein Apheresis (LA) still holds a valuable role, even in the new era of Lipid-Lowering Therapy (LLT) [2].…”

A place for bempedoic acid: an effective therapeutic cooperation

“…We consider that: (i) many patients with inherited hypercholesterolemia fail to achieve the Low Density Lipoprotein (LDL) cholesterol target despite PCSK9i therapy, especially in the presence of statin intolerance (in (my own experience 69% of patients with inherited hypercholesterolemia and ischemic heart disease fail to reach the LDL cholesterol target) 4 ; (ii) in Italian patients with a recent coronary artery event familial hypercholes-terolemia has relatively high prevalence (about 5.1%), indicating the need for the early identification of these subjects, which may help to improve their cardiovascular risk management 5 ; (iii) in the Italian PROSISA cohort, statin-associated muscle symptoms were reported in 9.6% of the patients and are a major determinant of poor treatment adherence and/or statin discontinuation 6 …”

“…We read with interest the position paper of Colivicchi et al 1 entitled 'Updated clinical evidence and place in therapy of bempedoic acid for hypercholesterolemia: Associazione Nazionale Medici Cardiologi Ospedalieri position paper' and the relative comments. 2,3 We consider that: (i) many patients with inherited hypercholesterolemia fail to achieve the Low Density Lipoprotein (LDL) cholesterol target despite PCSK9i therapy, especially in the presence of statin intolerance (in (my own experience 69% of patients with inherited hypercholesterolemia and ischemic heart disease fail to reach the LDL cholesterol target) 4 ; (ii) in Italian patients with a recent coronary artery event familial hypercholesterolemia has relatively high prevalence (about 5.1%), indicating the need for the early identification of these subjects, which may help to improve their cardiovascular risk management 5 ; (iii) in the Italian PROSISA cohort, statin-associated muscle symptoms were reported in 9.6% of the patients and are a major determinant of poor treatment adherence and/or statin discontinuation. 6 All these aspects lead us to suggest the additive effect of bempedoic acid to PCSK9i, instead of their alternative use, especially in specific cases such as heterozygous familial hypercholesterolemia with statin intolerance and previous coronary event.…”