Background: Statins are the mainstay of treatment for low-density lipoprotein cholesterol (LDL-C) lowering, however, some patients cannot tolerate statins because of adverse effects. Ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are alternative treatment options. The purpose of this meta-analysis was to compare LDL-C reduction with ezetimibe vs PCSK9i in patients not on statins.
Methods: PubMed and EMBASE were searched until 14th March 2020 for randomized clinical trials (RCTs) assessing the efficacy of ezetimibe vs PCSK9i in patients not on statins. The primary outcome was a reduction in LDL-C levels. A subgroup analysis of statin intolerant patients was also performed.
Results: We identified 8 RCTs that enrolled a total of 1602 patients comparing the two pharmacotherapies. PCSK9i lowered LDL-C levels significantly more than ezetimibe (mean difference (MD): -36.5; 95% confidence interval (CI) [-38.3, -34.7, p<0.00001, I=4%]. In the statin intolerant subgroup, PCSK9i showed significantly greater reduction in LDL-C levels compared with ezetimibe (MD: -36.1; 95% CI [-39.2, -33.1, p<0.00001, I=21%]. There were no significant differences in LDL-C reduction between different PCSK9i dosages (140 mg once every 2 weeks vs 420 mg once every 4 weeks) (MD: -1.87; 95% CI [-4.45, 0.71, p<0.16, I=0].
Conclusion: Among patients who are statin intolerant or not receiving statins, PCSK9i use is associated with significantly lower LDL-C levels than after treatment with ezetimibe. PCSK9i might be useful in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD) in this subset of patients.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.2174/1570161118666200807114559 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Variation in lipoprotein(a) response to potent lipid lowering: The role of apolipoprotein (a) isoform size.
J Clin Lipidol
December 2024
Center for the Prevention of Cardiovascular Disease, Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine. 530 First Avenue, HCC5, New York, NY 10016, USA. Electronic address:
Background: Lipoprotein(a) [Lp(a)] is a driver of residual cardiovascular risk. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) decrease Lp(a) with significant heterogeneity in response. We investigated contributors to the heterogeneous response.
View Article and Find Full Text PDFLipid Management in US Commercial and Medicare Enrollees with Atherosclerotic Cardiovascular Disease: Treatment Patterns and Low-Density Lipoprotein Cholesterol Control.
Am J Cardiol
January 2025
Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
Lipid-lowering therapy (LLT) is the cornerstone for secondary prevention of atherosclerotic cardiovascular disease (ASCVD), yet many patients exhibit low adherence to therapy and fail to achieve low-density lipoprotein cholesterol (LDL-C) goals. This retrospective cohort study used 2 nationally representative administrative closed claims databases (PharMetrics® Plus and Medicare Fee-for-Service [FFS] Research Identifiable Files) to identify commercial (C) and Medicare (M) enrollees with ASCVD between 2014-2019. Patients were stratified by exposure to statin therapy, ezetimibe and proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9i mAb) regimens.
View Article and Find Full Text PDFManagement of Hypercholesterolemia in Patients with Coronary Artery Disease: A Glimpse into the Future.
J Clin Med
December 2024
Interventional Cardiology, Sandro Pertini Hospital, 00157 Rome, Italy.
Cardio-cerebral vascular diseases due to atherosclerosis are still the leading cause of death worldwide. Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B have been identified as the primary factors responsible for the atherosclerotic process, with a causal effect. Many drugs aimed at reducing LDL-C levels are already on the market, acting in different ways in terms of mechanism of action, efficacy, and safety.
View Article and Find Full Text PDFTime to benefit of intensive lipid lowering therapy in individuals with cardiovascular disease.
J Clin Lipidol
October 2024
Department of Cardiology, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, China. Electronic address:
Article Synopsis
- - The study aimed to determine how long it takes for intensive lipid-lowering therapy to reduce major adverse cardiovascular events (MACE) in people with established cardiovascular disease (CVD), particularly before and after 2010 when new treatments like PCSK9 inhibitors and ezetimibe were introduced.
- - Researchers reviewed seven randomized controlled trials involving over 92,000 adults and found that it takes about 19.6 months of intensive therapy to prevent one MACE per 100 patients, with variations based on the treatment used.
- - Results showed that before 2010, high-intensity statin therapy required a TTB of 15.2 months, while PCSK9i and ezetimibe therapies had longer TTB
The effect of lipid-lowering treatment on indices of MASLD in familial hypercholesterolemia patients.
Clin Nutr
December 2024
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Medicine, Boston VA Healthcare System, Boston, MA, USA. Electronic address:
Background & Aims: The effect of lipid-lowering treatment (LLT) on metabolic dysfunction associated steatotic liver disease (MASLD) is unclear. This is relevant for patients with familial hypercholesterolemia (FH) who are on lifelong LLT. We aimed to evaluate the effect of LLT on MASLD indices in this population.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!