Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis
BackgroundThe objective of this study is to assess the relative efficacy of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab, evolocumab, and inclisiran, in conjunction with potent statins like atorvastatin and rosuvastatin, in patients presenting with hyperlipide...
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Frontiers Media S.A.
2025-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1415668/full |
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| author | Yuhua Jiang Yingying Wang Sijia Ma Linlin Qian Yeteng Jing Xi Chen Jinsheng Yang |
| author_facet | Yuhua Jiang Yingying Wang Sijia Ma Linlin Qian Yeteng Jing Xi Chen Jinsheng Yang |
| author_sort | Yuhua Jiang |
| collection | DOAJ |
| description | BackgroundThe objective of this study is to assess the relative efficacy of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab, evolocumab, and inclisiran, in conjunction with potent statins like atorvastatin and rosuvastatin, in patients presenting with hyperlipidemia or heightened cardiovascular risk attributable to elevated low-density lipoprotein cholesterol (LDL-C).MethodsA systematic search was conducted across databases including PubMed, Embase, and the Cochrane Library to explore lipid-lowering therapies in hyperlipidemia from their inception to 7 November 2023. A network meta-analysis (NMA) was conducted via Stata 17 software, with two authors independently conducting the search, screening, and data abstraction.ResultsA total of 68 clinical studies involving 21,288 patients with hyperlipidemia were incorporated into the NMA. PSCK9 inhibitors and potent statins significantly reduced LDL-C levels from baseline vs. placebo regardless of background therapy. Regarding the efficacy of lipid reduction, four principal medications were evaluated: evolocumab and atorvastatin [mean standard deviation (MD) −3.41, 95% CI −4.81 to −2.00] and evolocumab with rosuvastatin (MD −3.44, 95% CI −5.10 to −1.78) vs. placebo; alirocumab combined with rosuvastatin (MD −2.91, 95% CI −3.95 to −1.88) and alirocumab with atorvastatin (MD −2.90, 95% CI −3.97 to −1.84) vs. placebo. Meanwhile, compared with placebo, evolocumab (MD −1.89, 95% CI −2.27 to −1.50), alirocumab (MD −1.83, 95% CI −2.09 to −1.57), rosuvastatin (MD −1.93, 95% CI −2.30 to −1.56), inclisiran (MD −1.68, 95% CI −2.10 to −1.27), and atorvastatin (MD −1.68, 95% CI −2.04 to −1.31) could also play a role in the treatment of LDL-C reduction. Moreover, the incidence of adverse events (AEs) was similar to that observed in the control group, which included both placebo and potent statin groups, with no significant differences identified in our study (P > 0.05).ConclusionsThe combination of PCSK9 inhibitors with robust statins like rosuvastatin and atorvastatin markedly decreases LDL-C levels in patients with hyperlipidemia when compared to placebo or monotherapy. Notably, the pairing of evolocumab and atorvastatin exhibited exceptional efficacy in this investigation. In the interim, the combination of PCSK9 inhibitors and potent statins demonstrates a notable safety profile when contrasted with the control group. |
| format | Article |
| id | doaj-art-6ad4a66fc51340b0b6c5d78afa7abf2b |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-02-01 |
| publisher | Frontiers Media S.A. |
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| spelling | doaj-art-6ad4a66fc51340b0b6c5d78afa7abf2b2025-02-05T07:32:57ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-02-011110.3389/fcvm.2024.14156681415668Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysisYuhua Jiang0Yingying Wang1Sijia Ma2Linlin Qian3Yeteng Jing4Xi Chen5Jinsheng Yang6Institute of Basic Theory of Traditional Chinese Medicine, China Academic of Chinese Medical Sciences, Beijing, ChinaInstitute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, ChinaInstitute of Basic Theory of Traditional Chinese Medicine, China Academic of Chinese Medical Sciences, Beijing, ChinaInstitute of Basic Theory of Traditional Chinese Medicine, China Academic of Chinese Medical Sciences, Beijing, ChinaInstitute of Basic Theory of Traditional Chinese Medicine, China Academic of Chinese Medical Sciences, Beijing, ChinaInstitute of Basic Theory of Traditional Chinese Medicine, China Academic of Chinese Medical Sciences, Beijing, ChinaInstitute of Basic Theory of Traditional Chinese Medicine, China Academic of Chinese Medical Sciences, Beijing, ChinaBackgroundThe objective of this study is to assess the relative efficacy of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, such as alirocumab, evolocumab, and inclisiran, in conjunction with potent statins like atorvastatin and rosuvastatin, in patients presenting with hyperlipidemia or heightened cardiovascular risk attributable to elevated low-density lipoprotein cholesterol (LDL-C).MethodsA systematic search was conducted across databases including PubMed, Embase, and the Cochrane Library to explore lipid-lowering therapies in hyperlipidemia from their inception to 7 November 2023. A network meta-analysis (NMA) was conducted via Stata 17 software, with two authors independently conducting the search, screening, and data abstraction.ResultsA total of 68 clinical studies involving 21,288 patients with hyperlipidemia were incorporated into the NMA. PSCK9 inhibitors and potent statins significantly reduced LDL-C levels from baseline vs. placebo regardless of background therapy. Regarding the efficacy of lipid reduction, four principal medications were evaluated: evolocumab and atorvastatin [mean standard deviation (MD) −3.41, 95% CI −4.81 to −2.00] and evolocumab with rosuvastatin (MD −3.44, 95% CI −5.10 to −1.78) vs. placebo; alirocumab combined with rosuvastatin (MD −2.91, 95% CI −3.95 to −1.88) and alirocumab with atorvastatin (MD −2.90, 95% CI −3.97 to −1.84) vs. placebo. Meanwhile, compared with placebo, evolocumab (MD −1.89, 95% CI −2.27 to −1.50), alirocumab (MD −1.83, 95% CI −2.09 to −1.57), rosuvastatin (MD −1.93, 95% CI −2.30 to −1.56), inclisiran (MD −1.68, 95% CI −2.10 to −1.27), and atorvastatin (MD −1.68, 95% CI −2.04 to −1.31) could also play a role in the treatment of LDL-C reduction. Moreover, the incidence of adverse events (AEs) was similar to that observed in the control group, which included both placebo and potent statin groups, with no significant differences identified in our study (P > 0.05).ConclusionsThe combination of PCSK9 inhibitors with robust statins like rosuvastatin and atorvastatin markedly decreases LDL-C levels in patients with hyperlipidemia when compared to placebo or monotherapy. Notably, the pairing of evolocumab and atorvastatin exhibited exceptional efficacy in this investigation. In the interim, the combination of PCSK9 inhibitors and potent statins demonstrates a notable safety profile when contrasted with the control group.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1415668/fullhyperlipidemiaLDL-CPCSK9 inhibitorspotent statinsnetwork meta-analysis |
| spellingShingle | Yuhua Jiang Yingying Wang Sijia Ma Linlin Qian Yeteng Jing Xi Chen Jinsheng Yang Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis Frontiers in Cardiovascular Medicine hyperlipidemia LDL-C PCSK9 inhibitors potent statins network meta-analysis |
| title | Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis |
| title_full | Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis |
| title_fullStr | Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis |
| title_full_unstemmed | Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis |
| title_short | Efficacy and safety of PCSK9 inhibitors, potent statins, and their combinations for reducing low-density lipoprotein cholesterol in hyperlipidemia patients: a systematic network meta-analysis |
| title_sort | efficacy and safety of pcsk9 inhibitors potent statins and their combinations for reducing low density lipoprotein cholesterol in hyperlipidemia patients a systematic network meta analysis |
| topic | hyperlipidemia LDL-C PCSK9 inhibitors potent statins network meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1415668/full |
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