@article{3104312,
    title = "PCSK9 inhibitors in clinical practice: Novel directions and new experiences",
    author = "Rallidis, L.S. and Skoumas, I. and Liberopoulos, E.N. and Vlachopoulos, C. and Kiouri, E. and Koutagiar, I. and Anastasiou, G. and Kosmas, N. and Elisaf, M.S. and Tousoulis, D. and Iliodromitis, E.",
    journal = "Ελληνική καρδιολογική επιθεώρηση",
    year = "2020",
    volume = "61",
    number = "4",
    pages = "241-245",
    publisher = "Hellenic Cardiological Society",
    issn = "1011-7970",
    doi = "10.1016/j.hjc.2019.10.003",
    keywords = "alirocumab;  aminotransferase;  antilipemic agent;  atorvastatin;  creatine kinase;  evolocumab;  ezetimibe;  glucose;  hemoglobin A1c;  high density lipoprotein cholesterol;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  lipoprotein A;  low density lipoprotein cholesterol;  rosuvastatin;  triacylglycerol;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  low density lipoprotein cholesterol;  PCSK9 protein, human;  proprotein convertase 9, adult;  algorithm;  Article;  cardiovascular disease;  cerebrovascular accident;  clinical practice;  cohort analysis;  coronary artery disease;  drug efficacy;  drug hypersensitivity;  drug safety;  drug withdrawal;  familial hypercholesterolemia;  female;  human;  major clinical study;  male;  middle aged;  monotherapy;  myalgia;  risk assessment;  treatment failure;  familial hypercholesterolemia;  hypercholesterolemia, Cholesterol, LDL;  Humans;  Hydroxymethylglutaryl-CoA Reductase Inhibitors;  Hypercholesterolemia;  Hyperlipoproteinemia Type II;  Proprotein Convertase 9",
    abstract = "Background: In randomized clinical trials, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) effectively reduce low-density lipoprotein-cholesterol (LDL-C) with a favorable tolerability and safety profile. Our purpose is to provide real-world data regarding the indications, efficacy and safety of PCSK9i. Methods: The cohort comprised 141 patients who attended the lipid clinic of 3 hospitals in Greece and started using PCSK9i. Patients were requested to attend the lipid clinic at 3 months and at 1 year. Results: Ninety percent of patients had heterozygous familial hypercholesterolaemia (heFH) and 75% had cardiovascular disease (CVD). A PCSK9i [evolocumab 140 mg/2 weeks (n = 82), alirocumab 75 mg/2 weeks (n = 46) and alirocumab 150 mg/2 weeks (n = 13)] was prescribed due to failure to achieve LDL-C targets despite maximum lipid-lowering therapy (LLT) in 75% of patients, while in the remaining cases, the indication was statin intolerance. The mean reduction of LDL-C at 3 months was 56.2% and remained constant at 12 months (55.8% reduction from baseline). LDL-C target was achieved by 68.1% of patients at 3 months. “Totally” intolerant to statins patients (unable to tolerate any statin dose, n = 23) showed the lowest LDL-C reduction (47.7%). Side effects attributed to treatment were reported by 14 patients (10%). The total number of patients who stopped PCSK9i at 1 year was 14 (10%) but only 2 (1.4%) discontinued treatment because of side effects (myalgias). Conclusions: Our real-world results of PCSK9i showed comparable efficacy and tolerability to those reported in clinical trials and highlighted the value of treatment with PCSK9i heFH patients not achieving LDL-C targets despite maximum LLT and high or very high risk statin intolerant patients. © 2019 Hellenic Society of Cardiology"
}