Used in combination with statins, this class of drugs can lower LDL cholesterol by 70 percent
The Food and Drug Administration (FDA) recently approved Praluent, the first agent in a brand new class of cholesterol-lowering drugs (PCSK9 inhibitors), said to lower LDL (bad) cholesterol by as much as 50 percent to 70 percent when used as combination therapy. We sat down with Christopher Cannon, M.D., a cardiovascular medicine specialist at Brigham and Women’s Hospital in Boston, to discuss what this injectable drug means for people with high cholesterol and heart disease. These were the key points:
—“The issue of getting cholesterol levels down is something we try for all patients,” Dr. Cannon said. “The lower the better is the simple mantra we all follow.” For people with hereditary high cholesterol called heterozygous familial hypercholesterolemia and for folks who have heart disease and have had a cardiac event or procedure such as heart attack, stent or bypass surgery, Praluent appears to do the trick. “If a patient’s cholesterol levels are at 120, we can [with this new medication] get them down to 50,” he says. “That’s a huge drop.”
—So far, Praluent hasn’t been approved as stand-alone therapy, but to be used in conjunction with diet and the maximum dose of statin therapy a patient can tolerate. “A small group of the population can’t quite tolerate the maximum dosage of statins,” Dr. Cannon explained. “If you can’t go to the higher doses, you’re only getting 30 percent to 35 percent reduction, so these statin-intolerant people or can’t get to their goals with the current therapies.” For this population of people, using the new drug plus conventional statins provides a one-two punch to LDL cholesterol.
—In clinical trials, Praluent, which is an injection given once every two weeks, was very well tolerated without the side effects associated with statins.
—Recent research shows black folks have high cholesterol, but don’t know their levels or are unaware of the impact of high cholesterol on their health. Praluent’s approval may help draw attention to this. “When new therapies become available, it does spur discussion,” Dr. Cannon said. “Someone will say, ‘Did you hear about this new drug …’ which sparks conversation and engenders a positive discussion for groups who have a high level of cholesterol and heart disease. It leads people to ask, ‘What is my cholesterol?’ For African Americans, there has certainly always been a lot of discussion about high blood pressure, and it deserves priority number one attention. But cholesterol affects everybody in our society. If a new medication gets them into therapy—statins or the new therapy—that’s great. Praluent is really a game changer.”