Lipid profile of patients treated with evolocumab in Spanish hospital nephrology units (RETOSS NEFRO)

• Published in: Nefrología
• Main Authors: Goicoechea, Marian, Álvarez, Vicente, Segarra, Alfonso, Polaina, Manuel, Martín-Reyes, Guillermo, Robles, Nicolás Roberto, Escudero, Verónica, Orellana, Cristhian, Bea Granell, Sergio, de Juan-Ribera, Joaquín, Fernández Lucas, Milagros, Graña, Jose Maria, Reque, Javier, Sánchez Hernández, Rosa, Villamayor, Santiago, Górriz, Jose Luis
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 10-08-2021
• Subjects: c-LDL; Atherosclerotic cardiovascular disease; LDL-c; Evolocumab; Hipercolesterolemia familiar; Familial hypercholesterolemia; Nephrology units; Enfermedad cardiovascular ateroesclerótica; Unidades de nefrología
• ISSN: 2013-2514
• DOI: 10.1016/j.nefro.2021.06.004

To describe the clinical characteristics, the reasons for initiating therapy and the effects of treatment in the initial phase of evolocumab availability in the Nephrology Units of Spain.
Retrospective, observational and multicentric study that included patients initiating treatment with evolocumab (from February 2016 to August 2018), in 15 Nephrology Units in Spain. The demographic and clinical characteristics of the patients, the lipid lowering treatment and the evolution of the lipid profiles between 24 weeks pre-initiation and 12±4 weeks post-initiation of evolocumab were reviewed.
Sixty patients were enrolled: 53.3% women; mean (SD) age, 56.9 (12.8) years, 45.0% with familial hypercholesterolemia (FH) (5.0% homozygous and 40.0% heterozygous) and 65.0% with atherosclerotic cardiovascular (CV) disease. The mean (SD) eGFR was 62.6 (30.0)ml/min/1.73m
(51.7% of patients had eGFR<60ml/min/1.73m
[CKD stage>2]), 50.0% had proteinuria (>300mg/g) and 10.0% had nephrotic syndrome. Other CV risk factors were hypertension (75.0%), diabetes (25.0%), and smoking (21.7%). A 40.0% of patients were statin intolerant. At evolocumab initiation, 41.7% of patients were on a high-intensity statin, 18.3% on moderate intensity statin and 50.0% were receiving ezetimibe. Mean (SD) LDL-c at evolocumab initiation was 179.7 (62.9)mg/dL (53.4% of patients with LDL-c≥160mg/dL and 29.3%≥190mg/dL). After 12 weeks, evolocumab resulted in LDL-c reductions of 60.1%. At week 12, 90.0% of patients reached LDL-c levels <100mg/dL, 70.0% <70mg/dL, and 55.0% <55mg/dL, while mean eGFR levels and statin use were remained stable.
In Nephrology Units of Spain, evolocumab was predominantly prescribed in patients with FH, chronic renal disease (CRD>2) and secondary prevention, with LDL-c levels above those recommended by the guidelines. Evolocumab used in clinical practice significantly reduced the LDL-c levels in all patients included in the study.