Robinson Jennifer G, Heistad Donald D, Fox Keith A A
University of Iowa, USA.
University of Iowa, USA.
Atherosclerosis. 2015 Dec;243(2):593-7. doi: 10.1016/j.atherosclerosis.2015.10.023. Epub 2015 Oct 23.
Monoclonal antibodies (mAbs) to proprotein convertase subtilisin/kexin type 9 (PCSK-9) can further lower LDL-C by ≥60% in statin-treated patients. Preliminary data suggest they may reduce cardiovascular (CVD) events. Ongoing PCSK-9 mAb cardiovascular outcomes trials could provide the opportunity to determine whether a "legacy effect" similar to that observed for statins will occur over the post-trial observation period. We hypothesize these trials could demonstrate that (1) very aggressive LDL-C lowering with PCSK-9 mAbs added to background statin therapy will induce extensive atherosclerosis stabilization and regression in the large majority of treated patients, and (2) continued maintenance therapy with high intensity statin therapy (with or without ezetimibe) should then inhibit new plaque formation, with a long-term prevention of CVD events. The necessity of expensive lifetime treatment with PCSK-9 inhibitors could then be avoided in all but a small subset of patients who could benefit from longer treatment.
针对前蛋白转化酶枯草溶菌素9型（PCSK - 9）的单克隆抗体（mAbs）可使接受他汀类药物治疗的患者的低密度脂蛋白胆固醇（LDL - C）进一步降低≥60%。初步数据表明，它们可能会减少心血管（CVD）事件。正在进行的PCSK - 9单克隆抗体心血管结局试验可能会提供机会，以确定在试验后的观察期内是否会出现类似于他汀类药物所观察到的“遗留效应”。我们假设这些试验可能会证明：（1）在背景他汀类药物治疗基础上加用PCSK - 9单克隆抗体进行非常积极的LDL - C降低治疗，将在绝大多数接受治疗的患者中诱导广泛的动脉粥样硬化稳定和消退；（2）随后继续使用高强度他汀类药物治疗（联合或不联合依折麦布）应能抑制新斑块形成，从而长期预防CVD事件。除了一小部分可能从更长疗程治疗中获益的患者外，所有患者都可以避免使用PCSK - 9抑制剂进行昂贵的终身治疗。
