Effects of Inclisiran, Alirocumab, Evolocumab, and Evinacumab on Lipids: A Network Meta-Analysis.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Reviews in cardiovascular medicine Pub Date : 2025-02-22 eCollection Date: 2025-02-01 DOI:10.31083/RCM25248

Lin Zhang, Bin Li, Wei Chen, Wei Li, Huayun Yang, Diguang Pan

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引用次数: 0

Abstract

Background: Direct comparisons between the drugs are limited, and the dosing remains debatable. Therefore, the study aims to indirectly compare the efficacy and safety of inclisiran, alirocumab, evolocumab, and evinacumab in lipid-lowering through a network meta-analysis.

Methods: Databases including PubMed, EMBASE, Web of Science, and the Cochrane Library were utilized to retrieve randomized controlled trials (RCTs). The search was conducted up to July 1, 2023. The Cochrane risk of bias tool was employed to appraise the quality of included studies. R software was used to conduct the Bayesian network meta-analysis.

Results: Twenty-one RCTs with 10,835 patients were included. The network meta-analysis indicated that Evolocumab [mean difference (MD) = -60, 95% credibility interval (CrI) (-72, -49)] was the most effective (87%) in reducing low-density lipoprotein cholesterol (LDL-C), followed by alirocumab (71.4%) and inclisiran (47.2%), with placebo being the least effective (0.01%). In increasing high-density lipoprotein cholesterol (HDL-C), evolocumab [MD = 6.5, 95% CrI (3.2, 10)] ranked first (81.8%), followed by alirocumab (68.2%), with placebo again at the bottom (0.03%). In lowering total cholesterol, evolocumab [MD = -36, 95% CrI (-54, -19)] performed the best (86%), followed by alirocumab (64%), and placebo remained the least effective (0.04%). Regarding adverse events (AEs), evinacumab [odds ratio (OR) = 2, 95% CrI (1.17, 3.44)] ranked the highest (98.9%), followed by inclisiran (59.6%) and evolocumab (15.2%).

Conclusions: Evolocumab appears to be the most effective in increasing HDL-C and reducing LDL-C and total cholesterol. Evinacumab shows the best safety profile with the lowest incidence of AEs.

The prospero registration: CRD42024570445, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=570445.

查看原文本刊更多论文

Inclisiran, Alirocumab， Evolocumab和Evinacumab对血脂的影响：网络荟萃分析。

背景：药物之间的直接比较是有限的，剂量仍然存在争议。因此，本研究旨在通过网络meta分析，间接比较inclisiran、alirocumab、evolocumab和evinacumab在降脂方面的有效性和安全性。方法：利用PubMed、EMBASE、Web of Science、Cochrane Library等数据库检索随机对照试验（RCTs）。搜寻工作一直持续到2023年7月1日。采用Cochrane偏倚风险工具评价纳入研究的质量。采用R软件进行贝叶斯网络元分析。结果：纳入21项随机对照试验，共10,835例患者。网络荟萃分析显示，Evolocumab[平均差值(MD) = -60, 95%可信区间（CrI）（-72, -49）]在降低低密度脂蛋白胆固醇（LDL-C）方面最有效（87%），其次是alirocumab（71.4%）和inclisiran(47.2%)，安慰剂效果最差（0.01%）。在增加高密度脂蛋白胆固醇（HDL-C）方面，evolocumab [MD = 6.5, 95% CrI(3.2, 10)]排名第一（81.8%），其次是alirocumab(68.2%)，安慰剂再次垫底（0.03%）。在降低总胆固醇方面，evolocumab [MD = - 36,95% CrI(- 54,19)]表现最好（86%），其次是alirocumab(64%)，安慰剂仍然是最无效的（0.04%）。在不良事件（ae）方面，evinacumab[优势比(OR) = 2,95% CrI(1.17, 3.44)]排名最高（98.9%），其次是inclisiran（59.6%）和evolocumab（15.2%）。结论：Evolocumab似乎在增加HDL-C和降低LDL-C和总胆固醇方面最有效。Evinacumab的安全性最好，ae发生率最低。普洛斯彼罗注册：CRD42024570445， https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=570445。

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来源期刊

Reviews in cardiovascular medicine 医学-心血管系统

CiteScore

2.70

自引率

3.70%

发文量

377

审稿时长

1 months

期刊介绍： RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.