Real‐world study: Escalating targeted lipid‐lowering treatment with PCSK9‐inhibitors and lipoprotein apheresis

• Published in: Journal of clinical apheresis Vol. 34; no. 4; pp. 423 - 433
• Main Authors: Spitthöver, Ralf, Röseler, Tilmann, Julius, Ulrich, Heigl, Franz, Schettler, Volker J. J., Kühn, Ralf, Leebmann, Josef, Raabe, Andrea, Knittel, Markus, Schürfeld, Carsten, Moesenthin, Michael, Bernhardt, Wanja M., Röseler, Eberhard, Ketteler, Markus, Heibges, Andreas, Klingel, Reinhard
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-08-2019
• Subjects: Antibodies, Monoclonal - therapeutic use; Apheresis; Atherosclerosis - therapy; Blood Component Removal - methods; Cholesterol, LDL - isolation & purification; Combined Modality Therapy - methods; coronary artery disease; Enzyme Inhibitors - therapeutic use; Female; Humans; hypercholesterolemia; Hypercholesterolemia - therapy; Immunoglobulins; Lipids - isolation & purification; lipoprotein apheresis; lipoprotein(a); Lipoprotein(a) - isolation & purification; Lipoproteins; Lipoproteins - isolation & purification; low‐density lipoprotein cholesterol; Male; Middle Aged; PCSK9 antibodies; Proprotein Convertase 9 - antagonists & inhibitors; Proprotein Convertase 9 - immunology; coronary artery disease; lipoprotein apheresis; PCSK9 antibodies; lipoprotein(a); low-density lipoprotein cholesterol; hypercholesterolemia
• ISSN: 0733-2459; 1098-1101
• DOI: 10.1002/jca.21695

Introduction
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition with monoclonal antibodies has complemented the armamentarium of lipid‐lowering therapy (LLT) before the final step of commencing chronic lipoprotein apheresis (LA). Data are scarce on patients who, after escalation of LLT with PCSK9 antibodies, have commenced chronic LA or PCSK9 antibody treatment during ongoing long‐term LA.
Patients and Methods
In this study, a cohort of 110 patients with established atherosclerotic cardiovascular disease (ASCVD) due to hypercholesterolemia or concomitant lipoprotein(a)‐hyperlipoproteinemia, who received PCSK9 antibodies for the first time during routine care, were consecutively identified.
Results
Mean LDL‐C concentration prior to initiation of LA or PCSK9 antibody treatment was 5.3 ± 2.6 mmol/L (205 ± 102 mg/dL). Due to established ASCVD, the risk‐adjusted LDL‐C target value was <1.8 mmol/L (<70 mg/dL) in all patients. Use of PCSK9 antibodies increased the proportion of patients attaining the LDL‐C target concentration by 41.8% overall. Treatment emergent adverse events (TEAE) associated with PCSK9 antibody medication were reported in 35 patients (31.8%). Discontinuation of PCSK9 antibody therapy due to TEAEs occurred in 25 patients (22.7%).
Conclusion
Finally, 55.5% of patients received a combination of PCSK9 antibody therapy and LA at individually optimized treatment frequencies resulting in an increase of target attainment in 54.1% of patients. About 18.1% of chronic LA patients terminated LA treatment in this real‐world study. The termination of long‐term LA therapy, which has hitherto prevented the progression of ASCVD, requires careful individual risk assessment and cannot be recommended by the general criteria of LDL‐C reduction.