Evolocumab and alirocumab are monoclonal antibodies to an enzyme (PCSK9) involved in regulating LDL cholesterol (LDL-C) levels. They have now been registered in Australia to treat raised LDL-C levels in specific patient groups and appear generally safe and well tolerated. At least 50% reduction in LDL-C level can be expected. Cost pressures may prevent their wider use.
Despite ‘scare-mongering’ in the lay and some medical media, statin therapy to reduce elevated LDL cholesterol (LDL-C) levels is effective in reducing future cardiovascular (CV) events, this being accompanied by an acceptable side effect profile. Regrettably, long-term statin therapy does not abolish CV risk, either because there is a residual elevation in LDL-C or because patients cannot tolerate statins (principally because of muscle problems) or other causal factors are at play. This important unmet need may be addressed in part by a new type of therapy: inhibitors of the enzyme proprotein convertase subtilisin-kexin type 9 (PCSK9).
Picture credit: © John Bavosi/SPL