Patients with previous atherosclerotic
cardiovascular disease (ASCVD) and/or heterozygous
familial hypercholesterolemia (HeFH) are at high risk of future cardiovascular events. Despite maximally tolerated doses of
statins, many patients still have elevated
low-density lipoprotein cholesterol (
LDL-C) levels. We evaluated the efficacy and safety of
alirocumab in patients with ASCVD and/or HeFH on a maximally tolerated dose of
statin (
rosuvastatin 20 or 40 mg,
atorvastatin 40 or 80 mg, or
simvastatin 80 mg, or lower doses with an investigator-approved reason) ± other
lipid-lowering
therapies from 5 placebo-controlled phase 3 trials (52 to 78 weeks). Patients with (n = 2,449) and without (n = 1,050) ASCVD were pooled from the FH I, FH II, HIGH FH, LONG TERM, and COMBO I trials. Patients with HeFH with (n = 575) and without ASCVD (n = 682) were pooled from all trials except COMBO I. High-intensity
statins were utilized in 55.7% to 59.0% and in 72.4% to 87.6% of the ASCVD and the HeFH groups, respectively. Efficacy end points included
LDL-C percent change from baseline to week 24 stratified by
alirocumab dose. Mean baseline demographics and
lipid levels were comparable in
alirocumab- and placebo-treated patients.
LDL-C reductions from baseline at week 24 ranged from 46.6% to 51.3% for
alirocumab 75/150 mg and from 54.1% to 61.9% for
alirocumab 150 mg in ASCVD and HeFH groups and were sustained for up to 78 weeks.
LDL-C reductions with
alirocumab were independent of ASCVD and/or HeFH status (interaction p value >0.05). Concordant results were observed for other
lipids analyzed. The overall safety in the subgroups analyzed was similar in both treatment arms.
Injection-site reactions were observed more frequently with
alirocumab versus placebo.