2SPD-013 Effectiveness and efficiency of PCSK9 inhibitors: clinical practice experience

<h3>Background and Importance</h3> In recent years, the use of PCSK9 inhibitors (iPCSK9) has increased due to their results in lowering LDL cholesterol (LDL-C) and their corresponding impact on patients cardiovascular health. <h3>Aim and Objectives</h3> The primary objective is to compare the effectiveness and efficiency in reducing LDL-C between the off-label use of alirocumab 150 mg/month and the other dosing regimens indicated in the drug’s technical data sheet. The secondary objective is to compare the effectiveness between the iPCSK9 alirocumab and evolocumab. <h3>Material and Methods</h3> A retrospective observational study was conducted with patients from our hospital receiving any iPCSK9 in various dosing regimens. The following data were collected: iPCSK9 drug, dosing regimen, indication, and lipid profile. Patients without a second blood test or with a treatment duration of less than 28 days were excluded. To compare the mean LDL reduction between different treatment regimens, the Student-Fisher t-test was used. For cost calculations, prices were obtained through the nomenclator. <h3>Results</h3> 114 patients on iPCSK9 treatment were analysed, with 27 excluded. The overall reduction in LDL-C was −53.1 mg/dL (95% CI: −64.8 to −41.4). 20 patients on evolocumab achieved a mean LDL-C reduction of −61.36 mg/dL (95% CI: −89.1 to −33.6), while 67 patients on alirocumab demonstrated a mean LDL-C reduction of −50.6 mg/dL (95% CI: −63.7 to −37.5). No significant differences were observed between alirocumab and evolocumab: −10.8 mg/dL (95% CI: −38.6 to 17.1). Similarly, no significant differences were found between the 75 mg/2-week and 150 mg/4-week regimens of alirocumab, 14.5 mg/dL (95% CI: −24.5 to 53.5); nor between the 150 mg/2-week and 150 mg/4-week regimens, 6.4 mg/dL (95% CI: −50.8 to 30.8). The difference between alirocumab 300 mg/4-weeks and 150 mg/month was −13.7 mg/dL (95% CI: −58.3 to 30.8). All dosing regimens have the same monthly cost, except for the off-label regimen, which would result in a 50% cost reduction. <h3>Conclusion and Relevance</h3> Given that the monthly cost is the same for all alirocumab dosing regimens, and no significant differences were found between the regimens, the administration of alirocumab 150 mg/month was identified as the most efficient regimen. We found no significant differences in LDL-C reduction between the various alirocumab dosing regimens. Additionally, no differences were observed between alirocumab and evolocumab. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest