Clinical experience of switching between PCSK9-targeted drugs: effect on lipid parameters and frequency of achievement of therapeutic goals

Objective. To evaluate changes in lipid parameters and rates of LDL-C goal achievement after switching from inclisiran to alirocumab in patients at high, very high, and extreme risk of CVD. Material and methods. A retrospective observational study was conducted using data of 13 patients followed up at Clinical Hospital No. 101 of the branch of the Federal State Budgetary Institution of the North Caucasus Federal Scientific and Clinical Center of the Federal Medical and Biological Agency in Lermontov. Lipid parameters were analyzed prior to PCSK9-targeted therapy, after ≥2 injections of inclisiran, and after switching to alirocumab (≥1 injection). Results. Following treatment with inclisiran, mean LDL-C reduction was –67.7%, and after switching to alirocumab it amounted to –78.1% from baseline on background lipid-lowering therapy with statins and/or ezetimibe. The mean absolute difference between measurements on inclisiran and alirocumab was –0.5 mmol/L (p=0.0002). All lipid parameters (TC, LDL-C, HDL-C, TG) significantly improved after switching the PCSK9-targeted agent. In addition, more patients achieved treatment goals for LDL-C with alirocumab compared to inclisiran (100% vs 30.8%, p=0.0039). Conclusion. Switching from siRNA to direct PCSK9 inhibitors can improve lipid control in patients at high, very high, and extreme risk of CVD, ensuring more frequent achievement of therapeutic goals, which in turn may have a favorable impact on patient prognosis.