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在有或无混合性血脂异常的 2 型糖尿病患者中使用阿利西尤单抗的疗效和安全性:ODYSSEY LONG TERM 试验分析。

Efficacy and safety of alirocumab in individuals with type 2 diabetes mellitus with or without mixed dyslipidaemia: Analysis of the ODYSSEY LONG TERM trial.

机构信息

Cardiovascular Research Unit, Diabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland.

Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.

出版信息

Atherosclerosis. 2018 Sep;276:124-130. doi: 10.1016/j.atherosclerosis.2018.07.017. Epub 2018 Jul 21.


DOI:10.1016/j.atherosclerosis.2018.07.017
PMID:30059843
Abstract

BACKGROUND AND AIMS: Alirocumab, a monoclonal antibody to proprotein convertase subtilisin/kexin type 9, significantly reduces low-density lipoprotein cholesterol (LDL-C). We evaluated the efficacy and safety of alirocumab in individuals with type 2 diabetes mellitus (T2DM) with versus without mixed dyslipidaemia (MDL, defined as baseline LDL-C ≥70 mg/dL [1.8 mmol/L] and triglycerides ≥150 mg/dL [1.7 mmol/L]). METHODS: Data from 812 individuals with T2DM, from the placebo-controlled, 78-week, Phase 3 ODYSSEY LONG TERM trial of alirocumab 150 mg every 2 weeks (Q2W), on a background of maximally tolerated statins ± other lipid-lowering therapies, were pooled according to MDL status. Efficacy endpoints included percentage change from baseline to Week 24 in calculated LDL-C and other lipids/lipoproteins. RESULTS: In individuals with T2DM who received alirocumab 150 mg Q2W, mean LDL-C changes from baseline to Week 24 were -62.6% (vs. -6.0% with placebo) in those with MDL and -56.1% (vs. 5.6%) in those without MDL, with no significant between-group difference (p-interaction = 0.0842). Risk-based LDL-C goals (<70 [1.8 mmol/L] or <100 mg/dL [2.6 mmol/L]) were achieved by 69.1% and 72.4% of alirocumab-treated individuals with and without MDL, respectively. Mean reductions in non-high-density lipoprotein cholesterol (49.2% and 47.8%) and apolipoprotein B (50.2% and 49.1%) with alirocumab were also similar in those with and without MDL, respectively. Treatment-emergent adverse event rates were comparable between alirocumab-treated individuals with T2DM, with and without MDL. CONCLUSIONS: Reductions in LDL-C and other lipids with alirocumab, as well as safety and tolerability, were comparable between individuals with T2DM and with versus without MDL.

摘要

背景和目的:前蛋白转化酶枯草溶菌素/ kexin 9 型(PCSK9)单克隆抗体阿利西尤单抗可显著降低低密度脂蛋白胆固醇(LDL-C)。我们评估了阿利西尤单抗在合并混合血脂异常(MDL,定义为基线 LDL-C≥70mg/dL[1.8mmol/L]和甘油三酯≥150mg/dL[1.7mmol/L])的 2 型糖尿病(T2DM)患者中的疗效和安全性。

方法:从阿利西尤单抗 150mg,每 2 周(Q2W)皮下注射,在最大耐受他汀类药物±其他降脂治疗背景下进行的为期 78 周、安慰剂对照、3 期 ODYSSEY LONG TERM 试验的 812 名 T2DM 患者中,根据 MDL 状态对数据进行了汇总。疗效终点包括从基线到第 24 周时计算的 LDL-C 和其他血脂/脂蛋白的百分比变化。

结果:在接受阿利西尤单抗 150mg Q2W 的 T2DM 患者中,MDL 患者从基线到第 24 周的 LDL-C 变化为-62.6%(安慰剂组为-6.0%),无 MDL 患者为-56.1%(安慰剂组为 5.6%),两组间无显著差异(p 交互=0.0842)。风险为 LDL-C 目标(<70[1.8mmol/L]或<100mg/dL[2.6mmol/L])的患者分别占阿利西尤单抗治疗有和无 MDL 的患者的 69.1%和 72.4%。阿利西尤单抗治疗的患者的非高密度脂蛋白胆固醇(49.2%和 47.8%)和载脂蛋白 B(50.2%和 49.1%)的平均降幅在有和无 MDL 的患者中也相似。阿利西尤单抗治疗的 T2DM 患者中,治疗中出现的不良事件发生率在有和无 MDL 的患者中相似。

结论:阿利西尤单抗降低 LDL-C 和其他血脂的效果以及安全性和耐受性在合并 MDL 的 T2DM 患者中与不合并 MDL 的患者相似。

相似文献

[1]
Efficacy and safety of alirocumab in individuals with type 2 diabetes mellitus with or without mixed dyslipidaemia: Analysis of the ODYSSEY LONG TERM trial.

Atherosclerosis. 2018-7-21

[2]
Alirocumab therapy in individuals with type 2 diabetes mellitus and atherosclerotic cardiovascular disease: analysis of the ODYSSEY DM-DYSLIPIDEMIA and DM-INSULIN studies.

Cardiovasc Diabetol. 2019-11-9

[3]
Effect of alirocumab on individuals with type 2 diabetes, high triglycerides, and low high-density lipoprotein cholesterol.

Cardiovasc Diabetol. 2020-2-8

[4]
Design and rationale of the ODYSSEY DM-DYSLIPIDEMIA trial: lipid-lowering efficacy and safety of alirocumab in individuals with type 2 diabetes and mixed dyslipidaemia at high cardiovascular risk.

Cardiovasc Diabetol. 2017-5-25

[5]
Efficacy and safety of alirocumab in Korean patients with hypercholesterolemia and high cardiovascular risk: subanalysis of the ODYSSEY-KT study.

Korean J Intern Med. 2018-9-1

[6]
From lipoprotein apheresis to proprotein convertase subtilisin/kexin type 9 inhibitors: Impact on low-density lipoprotein cholesterol and C-reactive protein levels in cardiovascular disease patients.

Eur J Prev Cardiol. 2018-7-30

[7]
Efficacy and safety of alirocumab in patients with or without prior coronary revascularization: Pooled analysis of eight ODYSSEY phase 3 trials.

Atherosclerosis. 2018-7-10

[8]
Peripheral Artery Disease and Venous Thromboembolic Events After Acute Coronary Syndrome: Role of Lipoprotein(a) and Modification by Alirocumab: Prespecified Analysis of the ODYSSEY OUTCOMES Randomized Clinical Trial.

Circulation. 2020-5-19

[9]
Alirocumab vs usual lipid-lowering care as add-on to statin therapy in individuals with type 2 diabetes and mixed dyslipidaemia: The ODYSSEY DM-DYSLIPIDEMIA randomized trial.

Diabetes Obes Metab. 2018-3-23

[10]
Associations between lower levels of low-density lipoprotein cholesterol and cardiovascular events in very high-risk patients: Pooled analysis of nine ODYSSEY trials of alirocumab versus control.

Atherosclerosis. 2019-7-12

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[3]
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[5]
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[6]
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[7]
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[8]
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J Manag Care Spec Pharm. 2020-12

[9]
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[10]
Modern Lipid Management: A Literature Review.

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