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Efficacia comparativa degli inibitori di PCSK9 tramite una metanalisi network

Gli inibitori della proproteina della convertasi subtilisina/Kexin tipo 9 (PCSK9) evolocumab e alirocumab riducono sostanzialmente il colesterolo LDL quando aggiunti alla terapia con statine in pazienti che necessitano di una riduzione ulteriore lipidica.
Sulla base della metanalisi network presentata in questo articolo, gli inibitori di PCSK9 sono stati associati a riduzioni del colesterolo LDL dal 54% al 74% rispetto al placebo e dal 26% al 46% rispetto a ezetimibe in pazienti non adeguatamente controllati con le statine. Gli eventi avversi erano simili tra inibitori di PCSK9 e controllo.

Systematic review and network meta-analysis on the efficacy of evolocumab and other therapies for the management of lipid levels in hyperlipidemia

Toth PP, Worthy G, Gandra SR, Sattar N, Bray S, Cheng LI, Bridges I, Worth GM, Dent R, Forbes CA, Deshpande S, Ross J, Kleijnen J, Stroes ESG

J Am Heart Assoc. 2017;6:e005367

BACKGROUND: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors evolocumab and alirocumab substantially reduce low-density lipoprotein cholesterol (LDL-C) when added to statin therapy in patients who need additional LDL-C reduction.
METHODS AND RESULTS: We conducted a systematic review and network meta-analysis of randomized trials of lipid-lowering therapies from database inception through August 2016 (45 058 records retrieved). We found 69 trials of lipid-lowering therapies that enrolled patients requiring further LDL-C reduction while on maximally tolerated medium- or high-intensity statin, of which 15 could be relevant for inclusion in LDL-C reduction networks with evolocumab, alirocumab, ezetimibe, and placebo as treatment arms. PCSK9 inhibitors significantly reduced LDL-C by 54% to 74% versus placebo and 26% to 46% versus ezetimibe. There were significant treatment differences for evolocumab 140 mg every 2 weeks at the mean of weeks 10 and 12 versus placebo (-74.1%; 95% credible interval -79.81% to -68.58%), alirocumab 75 mg (-20.03%; 95% credible interval -27.32% to -12.96%), and alirocumab 150 mg (-13.63%; 95% credible interval -22.43% to -5.33%) at =12 weeks. Treatment differences were similar in direction and magnitude for PCSK9 inhibitor monthly dosing. Adverse events were similar between PCSK9 inhibitors and control. Rates of adverse events were similar between PCSK9 inhibitors versus placebo or ezetimibe.
CONCLUSIONS: PCSK9 inhibitors added to medium- to high-intensity statin therapy significantly reduce LDL-C in patients requiring further LDL-C reduction. The network meta-analysis showed a significant treatment difference in LDL-C reduction for evolocumab versus alirocumab.

J Am Heart Assoc. 2017;6:e005367