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American Journal of Cardiovascular Drugs

, Volume 19, Issue 1, pp 87–97 | Cite as

A Meta-Analysis of the Effect of PCSK9-Monoclonal Antibodies on Circulating Lipoprotein (a) Levels

  • Ye-Xuan Cao
  • Hui-Hui Liu
  • Sha Li
  • Jian-Jun LiEmail author
Original Research Article

Abstract

Background

Lipoprotein (a) [Lp(a)] is an atherogenic lipoprotein. While no effective therapy for Lp(a) is currently available, recently, several pooled analyses with small sample sizes have suggested that proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9-mAbs) could reduce circulating Lp(a) levels. This meta-analysis was performed to comprehensively investigate the efficacy of PCSK9-mAbs with respect to serum Lp(a) concentrations.

Methods

PubMed, MEDLINE, Embase, ClinicalTrials.gov, Cochrane CENTRAL, Web of Science and recent conferences up to July 2018 were searched. Randomized clinical trials evaluating the effect of PCSK9-mAbs and control treatment on plasma Lp(a) concentrations were included. Mean differences and odds ratios with 95% confidence intervals (CIs) were used.

Results

Twenty-seven randomized clinical trials with a total of 11,864 participants were included. PCSK9-mAbs showed a significant efficacy in reducing Lp(a) (− 21.9%, 95% CI − 24.3 to − 19.5), irrespective of PCSK9-mAb types, treatment duration, participant characteristics, treatment methods, differences of control treatment, baseline Lp(a) levels, and test methods. The greatest reduction was achieved with 150 mg alirocumab biweekly (− 24.6%, 95% CI − 28.0 to − 21.2) and  140 mg evolocumab monthly (− 26.8%, 95% CI − 31.6 to − 21.9). Meta-regression analyses found that the more intense low-density lipoprotein cholesterol levels declined during PCSK9-mAb treatment, the greater the reduction in Lp(a) levels. Safety was in accordance with previous reports.

Conclusions

The results of this analysis suggested that PCSK9-mAbs could significantly reduce circulating Lp(a) levels. Long-term studies may be needed to confirm the effect of PCSK9-mAbs on Lp(a) in the future.

Notes

Acknowledgements

We thank Dr. Zhang Y. for her cooperation regarding article screening.

Compliance with Ethical Standards

Funding

This work was supported by the Capital Health Development Fund (201614035) and CAMS Major Collaborative Innovation Project (2016-I2 M-1-011) awarded to Prof. Jian-Jun Li, MD, PhD. The sponsors had no role in the decision to conduct the meta-analyses, the data analysis, or the reporting of the results.

Conflict of interest

Ye-Xuan Cao, Hui–Hui Liu, Sha Li, and Jian-Jun Li declare that they have no conflicts of interest that might be relevant to the contents of this article.

Supplementary material

40256_2018_303_MOESM1_ESM.pdf (1.5 mb)
Supplementary material 1 (PDF 1505 kb)

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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical SciencesPeking Union Medical CollegeBeijingChina

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