Info

🌱 來自: Treatment of other lipid fractions

nonstatin drugs

Ezetimibe:

• Ezetimibe is a generic medication that lowers blood cholesterol level by inhibiting intestinal absorption and is FDA-approved for the treatment of primary hyperlipidemia and familial hypercholesterolemia.
• In the landmark IMPROVE-IT trial (view a NEJM Quick Take video summary and read the NEJM Journal Watch summary), patients who, after a hospitalization for acute coronary syndrome, were randomized to combination simvastatin–ezetimibe had fewer cardiovascular outcomes than those randomized to simvastatin–placebo.
• The benefit of ezetimibe (absolute risk difference, 2.0 percentage points in the primary outcome) was small, but ezetimibe is one of the few nonstatin agents to demonstrate a hard outcome benefit, and is the statin adjunct of choice for high-risk patients who do not achieve adequate LDL-C reduction.

PCSK9 Inhibitors:

• In 2015, the FDA approved aliROCumab (Praluent) and evoLOCumab (Repatha), two drugs in this new class of lipid-lowering agents.
• These drugs augment the uptake of circulating LDL in the liver by inhibiting proprotein convertase subtilisin–kexin type 9 (PCSK9), which normally binds LDL receptors for degradation and leads to decreased cellular ability to clear circulating LDL-C.
• They are FDA-approved for adjunctive use in patients with clinical ASCVD or familial hypercholesterolemia who have had an inadequate response to maximal statin therapy.
• The available efficacy data for alirocumab and evolocumab show that PCSK9 inhibitors can significantly lower LDL-C (up to 60%) and evolocumab and alirocumab trials demonstrate a reduction in the incidence of cardiovascular events in patients with ASCVD.
• Due to the results of the FOURIER trial (read the NEJM Journal Watch summary), evolocumab gained FDA indication to prevent cardiovascular events in patients with existing ASCVD.
• Ezetimibe should be added to maximal statin therapy prior to initiation of a PCSK9-inhibitor.