ALIROCUMAB : MECHANISM OF ACTION, PHARMACOKINETICS, SAFETY, AND CLINICAL OUTCOMES

Authors

  • Farah Medina Master of Clinical Pharmacy, Faculty of Pharmacy, Airlangga University
  • Sumarno - Faculty of Pharmacy, Airlangga University

Abstract

Hyperlipidemia is an established risk factor for developing cardiovascular disease (CVD). The latest guideline on lipid management emphasize treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) at doses proven to reduce CVD events.  However, some of statin-treated patients have persistently elevated cardiovascular risk due to inadequate lowering of low density lipoprotein cholesterol (LDL-C) levels. In addition, adverse effects of statins may limit their tolerability and therefore the ability to attain effective doses in some patients. A new class of drugs that inhibit proprotein convertase subtilisin-kexin type 9 (PCSK9) has been developed to treat hyperlipidemia.  PCSK9 inhibitors are monoclonal antibodies for proprotein convertase-subtilicin/kexin type 9 which significantly reduces the concentration of LDL-C in vivo by inhibiting the degradation of LDL receptors in hepatocytes. The introduction of the PCSK9 inhibitor was heralded a new era of intensive LDL-C reductions with LDL-C concentrations lowered below the rate that once thought possible with conventional treatments such as statins. On July 24, 2015, the United States Food and Drug Administration (FDA) approved Alirocumab, the first converged proprotein of the Subtilisin Kexin 9 (PCSK9) inhibitor. This review discusses the mechanisms of action, pharmacokinetics, safety and clinical outcomes of the Alirocumab.

References

Benjamin E, Virani S, Callaway C, Chamberlain A, Chang A, Cheng S, et al. Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation. 2018; 137(12).

Sirimarco G, Labreuche J, Bruckert E, Goldstein L, Fox K, Rothwell P et al. Atherogenic Dyslipidemia and Residual Cardiovascular Risk in Statin-Treated Patients. Stroke. 2014;45(5):1429-1436.

Karalis D, Victor B, Ahedor L, Liu L. Use of Lipid-Lowering Medications and the Likelihood of Achieving Optimal LDL-Cholesterol Goals in Coronary Artery Disease Patients. Cholesterol. 2012;2012:1-7.

Collins R, Reith C, Emberson J. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016; 388:2532–2561

US Food and Drug Administration, Office of Medical Products and Tobacco, Center for Drug Evaluation and Research, Division of Metabolism and Endocrinology Products. Briefing information for the June 9, 2015, meeting of the Endocrinologic and Metabolic Drugs Advisory Committee (EMDAC). BLA 125559, Praluent (alirocumab) injection.

https://www.fda.gov/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/ucm449863.htm. Updated June 5, 2015. Accessed May, 2019.

Roth M, McKenney M, Hanotin C, Asset G, Stein EA. Atorvastatin with or without an antibody to PCSK9 in primary hypercholesterolemia. N Engl J Med. 2012; 367:1891-1900.

Bergeron N, Phan B, Ding Y. Proprotein Convertase Subtilisin/Kexin Type 9 Inhibition: A New

Therapeutic Mechanism For Reducing Cardiovascular Disease Risk. Circulation. 2015; 132:1648–1666.

Burke A, Dron J, Hegele R, Huff M. PCSK9: Regulation and Target For Drug Development For Dyslipidemia. Annu. Rev. Pharmacol. Toxicol. 2017; 57:223–244.

Seidah N, Zuhier A, Chetien M, Mbikay M. PCKS: a key modulator of cardiovascular health. Circ. Res. 2014; 114:1022–1036.

Praluent (alirocumab) injection [prescribing information]. Bridgewater, NJ: sanofi-aventis US; Tarrytown, NY: Regeneron Pharmaceuticals; October 2015.

Nicolas X, Djebli N, Rauch C, Brunet A, Hurbin F, Martinez J et al. Population Pharmacokinetic/Pharmacodynamic Analysis of Alirocumab in Healthy Volunteers or Hypercholesterolemic Subjects Using an Indirect Response Model to Predict Low-Density Lipoprotein Cholesterol Lowering: Support for a Biologics License Application Submission: Part II. Clinical Pharmacokinetics. 2018;58(1):115-130.

Lunven C, Paehler T, Poitiers F, Brunet A, Rey J, Hanotin C et al. A Randomized Study of the Relative Pharmacokinetics, Pharmacodynamics, and Safety of Alirocumab, a Fully Human Monoclonal Antibody to PCSK9, After Single Subcutaneous Administration at Three Different Injection Sites in Healthy Subjects. Cardiovascular Therapeutics. 2014;32(6):297-301.

Roth M, Goldberg C, Catapano L. Antidrug Antibodies in Patients Treated with Alirocumab. N Engl J Med. 2017;376(1): 589-590

Schwartz G, Bessac L, Berdan L, Bhatt D, Bittner V, Diaz R et al. Effect of alirocumab, a monoclonal antibody to PCSK9, on long-term cardiovascular outcomes following acute coronary syndromes: Rationale and design of the ODYSSEY Outcomes trial. American Heart Journal. 2014;168(5):682-689.

Schwartz G, Bessac L, Berdan L, Bhatt D. The ODYSSEY OUTCOMES trial: topline results — alirocumab in patients after acute coronary syndrome. Presented at the 67th Scientific Sessions of the American College of Cardiology (2018)

Robinson G, Farnier M, Krempf M. Efficacy and safety of alirocumab in reducing lipids and cardiovascular events. N. Engl. J. Med. 2015; 372(1): 489–99.

Ginsberg N, Rader J, Raal J. Efficacy and safety of alirocumab in patients with heterozygous familial hypercholesterolemia and LDL-C of 160 mg/dl or higher. Cardiovasc. Drugs Ther. 2016;30:473–83.

Achimastos A, Alexandrides T, Alexopoulos D, Athyros V, Bargiota A, Bilianou E. Expert consensus on the rational clinical use of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Hormones (Athens). 2016;15:8–14.

Toth P, Dwyer J, Cannon C, Colhoun H, Rader D, Upadhyay A et al. Efficacy and safety of lipid lowering by alirocumab in chronic kidney disease. Kidney International. 2018;93(6):1397-1408.

Handelsman Y, Lepor N. PCSK9 Inhibitors in Lipid Management of Patients With Diabetes Mellitus and High Cardiovascular Risk: A Review. Journal of the American Heart Association. 2018;7(13).

Downloads

Published

2020-02-01

Issue

Section

Articles