Evolocumab: innovative opportunities for LDL-C AND LP (a) lowering and cardiovascular risk management

• Konovalov G.A.
• Bazhan S.S.

AbstractDespite proven effectiveness of statin therapy the target values of low density lipoproteins (LDL-C) are often not achieved on the therapy, especially in high- and very high-risk patients. Patients with statin intolerance and patients with familial hypercholesterolemia are most often faced with this problem. Thus, there remains a need for additional effective agents for reducing LDL cholesterol concetration. Evolocumab is the first approved representative of a new PCSK9 inhibitors class. The medicine is a monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9), which binding to LDL receptors in the liver and disrupts their normal recycling by their destruction. In phase III studies it was shown that subcutaneously injected evolocumab when used in monotherapy or on top of statins provides significant additional lowering of LDL-C (up to -75%), LP (a) (up to -36%) and triglycerides (up to -30%). Moreover, the safety profile in the clinical trials was comparable with a control group. Nonetheless, clinicians were interested in data on the effect of evolocumab on atherosclerosis in blood vessels and most importantly on major cardiovascular events. Answers to these, as well to a number of other questions, were received in November 2016 and in March 2017 in the results of GLAGOV and FOURIER studies, respectively. The data of the main clinical trials of evolocumab were summarized in the article, the authors» experience of evolocumab treatment in routine clinical practice is also provided.

Keywords:hypercholesterolemia, hyper-LP (a), Upid-lowering agents, proprotein convertase subtilisin/kexin type 9, PCSK9, evolocumab

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