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Guedeney P, Sorrentino S, Giustino G, et al. Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2021;7(3):225-235doi: 10.1093/ehjcvp/pvaa024.
Guedeney, P., Sorrentino, S., Giustino, G., Chapelle, C., Laporte, S., Claessen, B. E., Ollier, E., Camaj, A., Kalkman, D. N., Vogel, B., De Rosa, S., Indolfi, C., Lattuca, B., Zeitouni, M., Kerneis, M., Silvain, J., Collet, J. P., Mehran, R., & Montalescot, G. (2021). Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis. European heart journal. Cardiovascular pharmacotherapy, 7(3), 225-235. https://doi.org/10.1093/ehjcvp/pvaa024
Guedeney, Paul, et al. "Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis." European heart journal. Cardiovascular pharmacotherapy vol. 7,3 (2021): 225-235. doi: https://doi.org/10.1093/ehjcvp/pvaa024
Guedeney P, Sorrentino S, Giustino G, Chapelle C, Laporte S, Claessen BE, Ollier E, Camaj A, Kalkman DN, Vogel B, De Rosa S, Indolfi C, Lattuca B, Zeitouni M, Kerneis M, Silvain J, Collet JP, Mehran R, Montalescot G. Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2021 May 23;7(3):225-235. doi: 10.1093/ehjcvp/pvaa024. PMID: 32275743.
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Eur Heart J Cardiovasc Pharmacother. 2021 May 23;7(3):225-235. doi: 10.1093/ehjcvp/pvaa024.

Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis.

European heart journal. Cardiovascular pharmacotherapy

Paul Guedeney, Sabato Sorrentino, Gennaro Giustino, Celine Chapelle, Silvy Laporte, Bimmer E Claessen, Edouard Ollier, Anton Camaj, Deborah N Kalkman, Birgit Vogel, Salvatore De Rosa, Ciro Indolfi, Benoit Lattuca, Michel Zeitouni, Mathieu Kerneis, Johanne Silvain, Jean-Philippe Collet, Roxana Mehran, Gilles Montalescot

Affiliations

  1. Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France.
  2. Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  3. Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy.
  4. Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France.
  5. Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands.

PMID: 32275743 DOI: 10.1093/ehjcvp/pvaa024

Abstract

AIMS: Although alirocumab and evolocumab have both been associated with improved outcomes in patients with dyslipidaemia or established atherosclerotic cardiovascular disease, data on their respective performances are scarce. This study aimed at providing an indirect comparison of the efficacy and safety of alirocumab vs. evolocumab.

METHODS AND RESULTS: We conducted a systematic review and network meta-analysis of randomized trials comparing alirocumab or evolocumab to placebo with consistent background lipid-lowering therapy up to November 2018. We estimated the relative risk (RR) and the 95% confidence intervals (CIs) using fixed-effect model in a frequentist pairwise and network meta-analytic approach. A total of 30 trials, enrolling 59 026 patients were included. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. Compared with evolocumab, alirocumab was associated with a significant reduction in all-cause death (RR 0.80, 95% CI 0.66-0.97) but not in cardiovascular death (RR 0.83, 95% CI 0.65-1.05). This study did not find any significant differences in myocardial infarction (RR 1.15, 95% CI 0.99-1.34), stroke (RR 0.96, 95% CI 0.71-1.28), or coronary revascularization (RR 1.13, 95% CI 0.99-1.29) between the two agents. Alirocumab was associated with a 27% increased risk of injection site reaction compared to evolocumab; however, no significant differences were found in terms of treatment discontinuations, systemic allergic reaction, neurocognitive events, ophthalmologic events, or new-onset of or worsening of pre-existing diabetes.

CONCLUSION: Alirocumab and evolocumab share a similar safety profile except for injection site reaction. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to the heterogeneity of the studied populations treated with the two drugs.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].

Keywords: Alirocumab; Evolocumab; Lipid-lowering therapy; PCSK9 inhibitors

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