Abstract 11609: Neurological Effects of Proprotein Convertase Subtilisin/kexin Type 9(PCSK9) Inhibitors: Direct and Indirect Comparisons
Introduction: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors dramatically reduce low-density lipoprotein (LDL) cholesterol levels which may lead to lower cerebrovascular (CVA) events. However, randomized control trials (RCTs) have reported increased neurocognitive (NC) deficits in patients using PCSK9 inhibitors.
Hypothesis: CVA and NC event rates are similar in patients treated with or without PCSK9 inhibitors.
Methods: RCTs reporting rates of stroke, transient ischemic attacks (TIAs), and NC deficits in patients using PCSK9 inhibitors were identified. Standard meta-analyses techniques were used to compare these outcomes among patients treated with and without PCSK9 inhibitors. Network meta-analyses (NMA) were also conducted to indirectly compare Evolocumab and Alirocumab on aforementioned outcomes.
Results: Seventeen RCTs with 14,516 patients were included. Evolocumab was used in 10 RCTS in 6,403 patients whereas Alirocumab was used in 2,932 patients in 7 RCTs. Ten RCTs with 10,318 patients reported stroke. Fourteen RCTs with 12,578 patients reported NC event rates. Five RCTs with 6,710 patients reported TIAs (Table). None of the studies using Alirocumab reported data on TIAs. We did not observe any difference in stroke rate, NC deficits or TIAs among 2 studied groups (RR; 1.22, (95% CI: 0.50-2.96), 0.97 (0.43-2.20), and 0.37 (0.06-2.23)) respectively. We observed no difference in stroke and NC deficits among Evolocumab and Alirocumab with NMA (Figure).
Conclusions: PCSK9 inhibitors did not render any protection from stroke or TIAs. Furthermore, our pooled analysis does not show any increase in NC deficits as reported in previous studies.
Author Disclosures: N. Patel: None. R. Kalra: None. A. Venkatraman: None. H. Godara: None. G. Arora: None. N.S. Bajaj: None. P. Arora: None.
- © 2016 by American Heart Association, Inc.