PCSK9 Inhibitors

PCSK9-inhibitors are a class of biological drugs that block proprotein convertase subtilisin/kexin type 9, a protein that degrades LDL receptors. By inhibiting PCSK9, these drugs increase the number of LDL receptors on liver cells, leading to significantly lower levels of LDL-cholesterol. This reduction is highly effective in mitigating atherosclerotic plaque formation and reducing major adverse cardiovascular events, thereby extending healthy life years by preventing cardiovascular disease.

Verdict

Effective for high-risk patients to lower cardiovascular events.

Protocol

• Alirocumab is typically administered as a 75 mg or 150 mg subcutaneous injection once every two weeks.
• Evolocumab is typically administered as a 140 mg subcutaneous injection once every two weeks or 420 mg once a month.

Flags

• Requires subcutaneous injection, which some individuals may find uncomfortable.
• Potential for injection site reactions such as redness, pain, or bruising.
• Rare reported adverse events include allergic reactions, flu-like symptoms, and neurocognitive issues (though causality is debated).
• High cost of treatment may be a barrier without adequate insurance coverage.