Cardiovascular Research Unit, Diabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Atherosclerosis. 2018 Sep;276:124-130. doi: 10.1016/j.atherosclerosis.2018.07.017. Epub 2018 Jul 21.
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.
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。
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