PCSK9 inhibitors safe, effective in patients with heart transplants
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In heart transplant recipients, PCSK9 inhibitors lowered LDL, stabilized coronary intimal hyperplasia and were associated with minimal adverse effects, according to data from the virtual Heart Failure Society of America Scientific Meeting.
Yasser Sammour, MD, internal medicine resident at Saint Luke’s Mid-America Heart Institute, and colleagues analyzed 68 patients from Saint Luke’s who received a heart transplant from 1999 to 2019 and were prescribed a PCSK9 inhibitor after the transplant.
Among the cohort from the single-arm study (median age, 62 years; 78% men), the majority were prescribed a PCSK9 inhibitor due to elevated LDL and statin intolerance, according to a poster presented by Sammour and colleagues.
The agent was evolocumab (Repatha, Amgen) in 73.5% of patients, alirocumab (Praluent, Sanofi/Regeneron) in 13.2% and both in 13.2% (switched due to insurer preference), according to the researchers. In addition, 25% were taking a high-intensity statin and 29.4% were taking ezetimibe.
Median time between transplant and PCSK9 inhibitor initiation was 5.5 years and median time on a PCSK9 inhibitor was 1.4 years; 78% of patients were still taking a PCSK9 inhibitor at the time of the analysis.
Between PCSK9 inhibitor and the time of the analysis, median total cholesterol fell from 210 mg/dL to 133 mg/dL, median LDL fell from 125 mg/dL to 53 mg/dL, median non-HDL fell from 158 mg/dL to 82 mg/dL and median triglycerides fell from 163 mg/dL to 138 mg/dL (P < .001 for all), the researchers found. In addition, median HDL dropped from 46 mg/dL to 44 mg/dL (P = .007).
The researchers also reported median change in coronary intimal thickness on IVUS in patients for whom those data were available; 19 had IVUS before PCSK9 inhibitor initiation and at one follow-up visit, and eight had a second follow-up IVUS. There was no progression of atherosclerosis between the preinitiation IVUS and the first follow-up (P = .33) or between the first and second follow-up (P = .42), they found.
“Among heart transplant recipients, PCSK9 inhibitors are effective in lowering LDL levels and stabilizing coronary intimal hyperplasia with minimal side effects,” Sammour and colleagues wrote in the poster. “Further evaluation of PCSK9 inhibitor impact on post-heart transplant outcomes is warranted.”
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Sammour Y, et al. Abstract 054. Presented at: Heart Failure Society of America Scientific Meeting; Sept. 30-Oct. 6, 2020 (virtual meeting).
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