Efficacy and safety of different doses of evolocumab in reducing low-density lipoprotein cholesterol levels: A meta-analysis

Abstract

Evolocumab has been considered as an efficacious, safe and promising therapeutic modality for hyperchol-esterolemia and is associated with cardiovascular diseases. The efficacy and safety of two different doses of evolocumab were evaluated and the safety of evolocumab was compared with that of a placebo and ezetimibe. PubMed and EMBASE databases were searched and randomized controlled trials that examined the effect and safety of evolomucab compared with a placebo and ezetimibe were retrieved. Two authors independently performed article reviews and study quality evaluations. Odds ratios (ORs) were calculated using a fixed or random-effects model [95% confidence intervals (CIs)]. In the direct comparison, a significant reduction was observed in the muscle-associated events compared with ezetimibe [OR=0.54 (95% CI, 0.31-0.93); P (Z)=0.03, P (Q)=0.43, I2=0%]. In the adjusted indirect comparison of evolocumab 140 mg Q2W vs. evolocumab 420 mg Q4W, no significant differences in efficacy [OR=1.04 (95% CI, 0.55-1.99); P (Z)=0.90] or adverse events [OR=1.08 (95% CI, 0.66-1.74); P (Z)=0.76] were identified. The funnel plots of these direct comparison studies indicated that there was no publication bias. The results of this meta-analysis demonstrate that evolocumab significantly reduced low-density lipoprotein cholesterol levels, and no difference was noted between evolocumab 140 mg Q2W and evolocumab 420 mg Q4W. Furthermore, evolocumab had fewer muscle-associated events than ezetimibe.