Effectiveness and safety of injectable PCSK9 inhibitors in dyslipidaemias' treatment and cardiovascular disease prevention: An overview of 86 systematic reviews and a network metaanalysis.
Clin Investig Arterioscler
; 36(2): 86-100, 2024.
Article
em En, Es
| MEDLINE
| ID: mdl-38040529
ABSTRACT
OBJECTIVE:
Multiple systematic reviews (SR) have been performed on the effects of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), often providing conflicting findings. This overview and network meta-analysis (NMA) aimed to summarize SR findings on the efficacy and safety of PCSK9i and provide an updated NMA. MATERIALS ANDMETHODS:
MEDLINE (Pubmed), Scopus, Cochrane, Epistemonikos and Google Scholar were searched from inception to September 21, 2023 for SRs of randomized controlled trials (RCTs) and from January 1, 2020 to September 21, 2023 for additional RCTs. Double-independent study selection, data extraction and quality assessment were performed. Qualitative analysis was performed for SRs and a frequentist random-effects model NMA was performed for RCTs.RESULTS:
Totally, 86 SRs and 76 RCTs were included. Alirocumab (77/86 [90%]) and evolocumab (73/86 [85%]) were mostly analyzed. Associations from SRs (35/42 [83%]) and the updated NMA indicated PCSK9i benefit on major adverse cardiovascular events (MACEs). Reductions were also noted for cerebrovascular events (47/66 [71%]), coronary revascularization (29/33 [88%]) and myocardial infarction (41/63 [65%]). Alirocumab was associated with reductions on all-cause mortality (RR=0.82, 95%CI [0.72,0.94]). Data on any CV event reduction were conflicting (7/16 [44%]). Inclisiran appeared effective only on MACEs (RR=0.76, 95%CI [0.61,0.94]). No reductions in heart failure were observed (0/16). No increases were identified between PCSK9i and any (0/35) or serious adverse events (0/52). However, PCSK9i were associated with injection-site reactions (20/28 [71%]).CONCLUSION:
PCSK9i appeared to be effective in CV outcomes and their clinical application was generally safe.Palavras-chave
Cardiología preventiva; Dislipidemias; Dyslipidemias; Effectiveness and safety of interventions; Eficacia y seguridad de las intervenciones; Inhibidores de la proproteína convertasa subtilisina/kexina tipo 9 (PCSK9); Metaanálisis en red; Network meta-analysis; Overview of reviews; Preventive cardiology; Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors; Visión general de revisiones sistemáticas
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doenças Cardiovasculares
/
Dislipidemias
/
Anticolesterolemiantes
Limite:
Humans
Idioma:
En
/
Es
Ano de publicação:
2024
Tipo de documento:
Article