Title:Alirocumab versus Evolocumab on Cardiovascular Outcomes: A Systematic Review and Meta-analysis
Volume: 22
Issue: 1
Author(s): Andre Saad Cleto*, Joao Matheus Schirlo, Janete Machozeki and Camila Marinelli Martins
Affiliation:
- Department of Medicine, State University of Ponta Grossa, Ponta Grossa, Brazil
Keywords:
Alirocumab, evolocumab, cardiovascular outcomes, PCSK9 inhibitors, hypercholesterolemia, LDL-C receptors.
Abstract:
Introduction: The PCSK9 enzyme is present mainly in the liver and is responsible for
the degradation of LDL-C receptors. Currently, there are some drugs that inhibit this enzyme,
such as alirocumab and evolocumab. Consequently, these drugs reduce serum LDL-C levels.
Therefore, a systematic review and a meta-analysis were carried out in order to compare alirocumab
against evolocumab in reducing cardiovascular outcomes.
Methods: This systematic review was carried out in accordance with PRISMA and was registered
in PROSPERO (CRD42024573217). The following databases were searched on July, 9,
2024: PubMed, Web of Science and Scopus. Randomized clinical trials with a control group
were included and meta-analyses were performed to assess relative risk (RR). The random effects
model was used in heterogeneous samples. The articles were distributed into 2 subgroups:
use of alirocumab and evolocumab.
Results: Initially, 2,213 articles were found, of which 6 were included. In total, 62,119 patients
participated. The RR values were significant for alirocumab in the following outcomes: myocardial
infarction (MI) 0.85 (95% CI 0.77-0.93), stroke 0.75 (95% CI 0.60-0.94) and hospitalization
for unstable angina 0.58 (95% CI 0.39-0.86), while for evolocumab they were significant for MI
0.75 (95% CI 0.68-0.83) and coronary revascularization 0.81 (95 CI % 0.75-0.88). There was a
statistically significant difference between the drugs for hospitalization for unstable angina
(p=0.02).
Discussion: This study highlights the benefits of PCSK9 inhibitors, especially alirocumab, in
reducing major cardiovascular events. Alirocumab significantly lowered hospitalizations for
unstable angina, with a 42% reduction, and showed favorable outcomes in reducing myocardial
infarction, coronary revascularization, and stroke. These reductions are clinically meaningful, as
they lower morbidity, improve patient quality of life, and reduce healthcare costs. Both alirocumab
and evolocumab are effective and safe, offering important therapeutic options for high-risk
cardiovascular patients.
Conclusion: The use of alirocumab is preferable if the focus is to avoid hospitalizations for unstable
angina or stroke, while evolocumab may be an option if one wants to avoid coronary revascularization.
Both drugs are effective in reducing cardiovascular outcomes, but alirocumab
was superior to evolocumab.
