Frederick J. Raal*, Robert Chilton, Naresh Ranjith, Virendra Rambiritch, Rory F. Leisegang, Iftikhar O. Ebrahim, Alet van Tonder, Nelusha Shunmoogam, Célia Bouharati, Moji G. Musa, Sumanth Karamchand, Poobalan Naidoo and D. J. Blom Pages 1 - 15 ( 15 )
Background: Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are a novel class of non-statin lipid lowering therapy that reduce LDL-cholesterol by 50 - 60%. PCSK9 inhibitors decrease LDL-cholesterol by preventing intracellular degradation of LDL receptors; subsequently, a greater number of LDL-receptors are available on the cell surface to extract circulating LDL.
Objective: To describe the origins of PCSK9 inhibitors and their current use in clinical practice.
Methods: We performed a narrative review of the PCSK9 inhibitor class of drugs.
Results: Current data indicate that PCSK9 inhibitors effectively reduce LDL-cholesterol and are well tolerated and safe. PCSK9 inhibitors have also been shown to reduce cardiovascular event rates in patients with stable atherosclerotic cardiovascular disease and in patients with a recent (up to one year) acute coronary syndrome. Given the costs, chronicity of the treatment and the potential budget impact, PCSK9 inhibitors are often limited to patients with the highest absolute risk for major adverse cardiovascular events despite optimal treatment with high-intensity statin and ezetimibe.
Conclusion: PCSK9 inhibitors have a favorable safety, efficacy and tolerability profile. Postmarketing safety surveillance and real-world studies are needed to further support the long-term safety profile of this class of medicine.
PCSK9 inhibitors, LDL-cholesterol, atherosclerotic cardiovascular disease, major adverse cardiovascular events, acute coronary syndrome, high intensity statin, ezetimibe.
Department of Medicine, Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Department of Medicine, Faculty of Medicine, Division of Cardiology and Interventional Cardiology, University of Texas Health Science Center at San Antonia, Texas, Department of Cardiology, Cardiovascular Research Centre, Durban, Department of Pharmacology, Faculty of Health Sciences, Discipline of Pharmaceutical Sciences, University of Kwa-Zulu Natal, Durban, Department of Pharmaceutical Biosciences, Faculty of Pharmacy, Uppsala University, Uppsala, Department of Cardiology, Netcare Unitas Hospital, Pretoria, Department of Diabetes and Cardiovascular Medicine, Medical Affairs, Sanofi, Midrand, Department of Diabetes and Cardiovascular Medicine, Medical Affairs, Sanofi, Midrand, Department of Clinical Trials, Clinical Study Unit, Sanofi, Midrand, Department of Diabetes and Cardiovascular Medicine, Medical Affairs, Sanofi, Midrand, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Department of Diabetes and Cardiovascular Medicine, Medical Affairs, Sanofi, Midrand, Department of Medicine, Division of Lipidology and Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town