Evaluation of the Effectiveness and Safety of Alirocumab Use in Statin-Intolerant Veterans

Abstract

Background Since 1987, statin therapy has been the mainstay of treatment for hypercholesterolemia, and current practice guidelines recommend statins as first-line therapy given demonstrated reductions in elevated low-density lipoprotein cholesterol (LDL-C) and cardiovascular (CV) mortality reduction in robust clinical trials. The primary objective of this case series was to assess LDL-C reduction associated with alirocumab use in statin-intolerant veterans at a single US Department of Veterans Affairs medical center. The secondary objective was to assess the incidence of CV events. Methods A retrospective chart review was conducted to identify statin-intolerant veterans who were initiated on treatment with alirocumab for LDL-C and/or CV risk reduction between June 2017 and May 2019. Electronic health records of all eligible patients who received alirocumab were reviewed, and basic demographics (patient age, sex, and race/ethnicity) as well as medical characteristics at baseline were collected. Baseline LDL-C was compared with levels at 4 and 24 weeks. Results Although a majority of patients saw a significant and clinically meaningful reduction in LDL-C, the group of patients with an increase in LDL-C may have benefitted from targeted intervention to improve medication and dietary adherence. Conclusions Alirocumab use in 24 statin-intolerant veterans resulted in a significant reduction in LDL-C at 4 and 24 weeks after initiation. Large long-term studies would better evaluate CV benefit associated with alirocumab therapy in a veteran population.