Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis
Background: Direct comparisons between the drugs are limited, and the dosing remains debatable. Therefore, the study aims to indirectly compare the efficacy and safety of inclisiran, alirocumab, evolocumab, and evinacumab in lipid-lowering through a network meta-analysis....
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| Format: | Article |
| Language: | English |
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IMR Press
2025-02-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/26/2/10.31083/RCM25248 |
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| author | Lin Zhang Bin Li Wei Chen Wei Li Huayun Yang Diguang Pan |
| author_facet | Lin Zhang Bin Li Wei Chen Wei Li Huayun Yang Diguang Pan |
| author_sort | Lin Zhang |
| collection | DOAJ |
| description | Background: Direct comparisons between the drugs are limited, and the dosing remains debatable. Therefore, the study aims to indirectly compare the efficacy and safety of inclisiran, alirocumab, evolocumab, and evinacumab in lipid-lowering through a network meta-analysis. Methods: Databases including PubMed, EMBASE, Web of Science, and the Cochrane Library were utilized to retrieve randomized controlled trials (RCTs). The search was conducted up to July 1, 2023. The Cochrane risk of bias tool was employed to appraise the quality of included studies. R software was used to conduct the Bayesian network meta-analysis. Results: Twenty-one RCTs with 10,835 patients were included. The network meta-analysis indicated that Evolocumab [mean difference (MD) = –60, 95% credibility interval (CrI) (–72, –49)] was the most effective (87%) in reducing low-density lipoprotein cholesterol (LDL-C), followed by alirocumab (71.4%) and inclisiran (47.2%), with placebo being the least effective (0.01%). In increasing high-density lipoprotein cholesterol (HDL-C), evolocumab [MD = 6.5, 95% CrI (3.2, 10)] ranked first (81.8%), followed by alirocumab (68.2%), with placebo again at the bottom (0.03%). In lowering total cholesterol, evolocumab [MD = –36, 95% CrI (–54, –19)] performed the best (86%), followed by alirocumab (64%), and placebo remained the least effective (0.04%). Regarding adverse events (AEs), evinacumab [odds ratio (OR) = 2, 95% CrI (1.17, 3.44)] ranked the highest (98.9%), followed by inclisiran (59.6%) and evolocumab (15.2%). Conclusions: Evolocumab appears to be the most effective in increasing HDL-C and reducing LDL-C and total cholesterol. Evinacumab shows the best safety profile with the lowest incidence of AEs. The PROSPERO registration: CRD42024570445, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=570445. |
| format | Article |
| id | doaj-art-ce54cd8b157e44d98a4cfb8262914f41 |
| institution | OA Journals |
| issn | 1530-6550 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj-art-ce54cd8b157e44d98a4cfb8262914f412025-08-20T02:11:13ZengIMR PressReviews in Cardiovascular Medicine1530-65502025-02-012622524810.31083/RCM25248S1530-6550(24)01618-1Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-AnalysisLin Zhang0Bin Li1Wei Chen2Wei Li3Huayun Yang4Diguang Pan5Department of Cardiology, Guilin People’s Hospital, 541002 Guilin, Guangxi, ChinaDepartment of Cardiology, Guilin People’s Hospital, 541002 Guilin, Guangxi, ChinaDepartment of Cardiology, Guilin People’s Hospital, 541002 Guilin, Guangxi, ChinaDepartment of Cardiology, Guilin People’s Hospital, 541002 Guilin, Guangxi, ChinaDepartment of Cardiology, Guilin People’s Hospital, 541002 Guilin, Guangxi, ChinaDepartment of Cardiology, Guilin People’s Hospital, 541002 Guilin, Guangxi, ChinaBackground: Direct comparisons between the drugs are limited, and the dosing remains debatable. Therefore, the study aims to indirectly compare the efficacy and safety of inclisiran, alirocumab, evolocumab, and evinacumab in lipid-lowering through a network meta-analysis. Methods: Databases including PubMed, EMBASE, Web of Science, and the Cochrane Library were utilized to retrieve randomized controlled trials (RCTs). The search was conducted up to July 1, 2023. The Cochrane risk of bias tool was employed to appraise the quality of included studies. R software was used to conduct the Bayesian network meta-analysis. Results: Twenty-one RCTs with 10,835 patients were included. The network meta-analysis indicated that Evolocumab [mean difference (MD) = –60, 95% credibility interval (CrI) (–72, –49)] was the most effective (87%) in reducing low-density lipoprotein cholesterol (LDL-C), followed by alirocumab (71.4%) and inclisiran (47.2%), with placebo being the least effective (0.01%). In increasing high-density lipoprotein cholesterol (HDL-C), evolocumab [MD = 6.5, 95% CrI (3.2, 10)] ranked first (81.8%), followed by alirocumab (68.2%), with placebo again at the bottom (0.03%). In lowering total cholesterol, evolocumab [MD = –36, 95% CrI (–54, –19)] performed the best (86%), followed by alirocumab (64%), and placebo remained the least effective (0.04%). Regarding adverse events (AEs), evinacumab [odds ratio (OR) = 2, 95% CrI (1.17, 3.44)] ranked the highest (98.9%), followed by inclisiran (59.6%) and evolocumab (15.2%). Conclusions: Evolocumab appears to be the most effective in increasing HDL-C and reducing LDL-C and total cholesterol. Evinacumab shows the best safety profile with the lowest incidence of AEs. The PROSPERO registration: CRD42024570445, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=570445.https://www.imrpress.com/journal/RCM/26/2/10.31083/RCM25248total cholesterollow density lipoprotein cholesterinhigh density lipoprotein |
| spellingShingle | Lin Zhang Bin Li Wei Chen Wei Li Huayun Yang Diguang Pan Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis Reviews in Cardiovascular Medicine total cholesterol low density lipoprotein cholesterin high density lipoprotein |
| title | Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis |
| title_full | Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis |
| title_fullStr | Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis |
| title_full_unstemmed | Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis |
| title_short | Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis |
| title_sort | effects of inclisiran alirocumab evolocumab and evinacumab on lipids a network meta analysis |
| topic | total cholesterol low density lipoprotein cholesterin high density lipoprotein |
| url | https://www.imrpress.com/journal/RCM/26/2/10.31083/RCM25248 |
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