Evolocumab + high-intensity statins allow 95% to reach LDL-C targets post-ACS

  • Koskinas KC & al.
  • J Am Coll Cardiol
  • 16 Aug 2019

  • International Clinical Digest
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Takeaway

  • Evolocumab added to high-intensity statins after acute coronary syndrome (ACS) results in more than 95% of patients achieving low-density lipoprotein cholesterol (LDL-C) targets.
  • The combination was well tolerated in this randomised, placebo-controlled trial. 

Why this matters

  • This proprotein convertase subtilisin/kexin type 9 (PCSK9) antibody has not been studied before in the acute post-ACS in-hospital setting, say these authors.

Key results

  • At week 8, mean LDL-C decreased from:
    • 3.61 to 0.79 mmol/L with evolocumab; vs
    • 3.42 to 2.06 mmol/L with placebo; and
    • Difference in mean percentage change from baseline: −40.7% (95% CI, −45.2% to −36.2%; P<.001>
  • By week 8, LDL-C target of
  • 95.7% in the evolocumab group; vs
  • 37.6% with placebo; and
  • Mean differences: 
    • −55.8% (95% CI, −70.1% to −41.6%) for evolocumab, vs 
    • −36.5% (95% CI, −40.5% to −32.5%; Pinteraction<.001>
  • Other beneficial lipid changes also seen.
  • Adverse event rates were similar between drug and placebo. 
  • Study design

    • Randomised, placebo-controlled, double-blind trial, 308 patients in hospital post-ACS, from January 23, 2018 to March 8, 2019, with high LDL-C, on a high-intensity statin ≥4 weeks.
    • Patients randomly allocated to 420 mg subcutaneous evolocumab or placebo.
    • Primary endpoint: percentage change in LDL-C from baseline to 8-week follow-up.
    • Funding: Amgen.

    Limitations

    • Modest sample size.