Background and aims: Statins has long been used as first line treatment option for hypercholesterolemia however; half of population doesnt achieve target LDL reduction. Proprotein convertase subtilisin kexin 9 inhibitors (PCSK9i) are a promising addition to anti-dyslipidemic armamentarium. Aim of this study is to find out the efficacy of PCSK9 inhibitors in a district general hospital of Northwest of England.
Method: We identified all the patient who have been prescribed PCSK9 inhibitors in last 3 years from home care pharmacy record and had at least 2 lipid profile done at baseline before starting PCSK9 inhibitors and latest at least 612 months later.
Results: Our study included 11 patients; all of them were on Evolocumab 120 mg every 2 weeks. 54.5% (n=6) had definite FH, 27.2% (n=3) had possible FH and 18.1% (n=2) had polygenic hypercholesterolemia. 36.3% (n=4) of patients were statin intolerant. Amongst statin intolerant group of 4 patients, 1 patient had serious side-effects with PCSK9i needing withdrawal of treatment. Amongst the patients who tolerated PCSK9i, median baseline LDL-C was 5.9 mmol/l and median LDL-C 612 months post PCSK9i treatment was 1.65 mmol/l with mean reduction of 58%. Side effects were reported in 18.1% (n=2) patients, 1 of them were previously intolerant to statins and treatment has to be discontinued in that patient. Mean reduction in LDL-C in patients intolerant to statins who tolerated PCSK9i was 56%, while mean reduction in LDL-C was 59% in patients who tolerated both statins and PCSK9i.
Conclusion: Our observation shows that mean LDL-C reduction with PCSK9 inhibitors in routine clinical practice is comparable to FOURIER, ODYSSEY ALTERNATIVE and GUASS-3 trial.