evolocumab PCSK9 inhibitor role in atherosclerotic disease - FOURIER Trial

FOURIER Trial Key Points:

  1. FOURIER trial established the role of PCSK9 inihibitor therapy in reducing future cardiovascular events and mortality.
  2. Evolocumab showed benefit in terms of cardiovascular disease but didn’t show any mortality benefit.
  3. These agents were utilized in patients who were already on moderate to high intensity statin therapy.
  4. PCSK9 inhibition was well-tolerated without excess new-onset diabetes or neurocognitive effects despite dramatic LDL reduction.

Guidelines on PCSK9 inhibition – ACC 2017 Update for Non-Statin Therapy

  1. If patients with clinical ASCVD and comorbidities require >25% additional lowering of LDL-C, a PCSK9 inhibitor may be preferred as the initial non-statin agent.
  2. If patients with clinical ASCVD and baseline LDL-C ≥190 mg/dL require >25% additional lowering of LDL-C or have additional comorbidities as defined in the previous text, a PCSK9 inhibitor may be preferred as the initial non-statin agent.
  3. If high-risk patients with baseline LDL-C ≥190 mg/dL require additional LDL-C lowering (<50% reduction in LDL-C, may consider LDL-C ≥100 mg/dL or non–HDL-C ≥130 mg/dL) after the addition of a single non-statin agent (i.e., ezetimibe) to maximally tolerated statin therapy, it is reasonable to consider the addition of a second non-statin agent (i.e., ezetimibe plus PCSK9 inhibitor).
  4. Read full guidelines at ACC

Source: NEJM