Temel Kavramlar
Initiating the cholesterol-lowering drug inclisiran earlier in the treatment pathway leads to significantly better long-term low-density lipoprotein (LDL) reduction compared to usual care in patients with atherosclerotic cardiovascular disease (ASCVD).
Özet
The study, known as VICTORION-INITIATE, compared an "inclisiran first" strategy, where inclisiran was added immediately if patients failed to reach LDL-C < 70 mg/dL despite receiving maximally tolerated statins, to usual care in 450 patients with ASCVD.
The key findings are:
- At day 330, the mean change in LDL from baseline was -60.0% with the inclisiran first strategy compared to -7.0% with usual care (p<0.001).
- A significantly greater proportion of patients in the inclisiran first arm achieved LDL goals of < 70 mg/dL (81.8% vs 22.2%) or < 55 mg/dL (71.6% vs 8.9%) compared to the usual care arm.
- Only 12.6% of patients in the usual care group received statins in combination with other lipid-lowering therapies, and only 2.5% received a PCSK9 monoclonal antibody without concomitant statins.
- The study was designed to represent real-world US clinical practice, and the lack of lipid therapy use and intensification in the usual care arm may reflect an inadequately resourced population with limited access to non-statin therapies.
- The authors conclude that the results demonstrate the clinical value of initiating inclisiran earlier in the treatment pathway and highlight the urgent need to improve usual care for US patients with ASCVD.
İstatistikler
At day 330, the mean change in LDL from baseline was -60.0% with the inclisiran first strategy compared to -7.0% with usual care (p<0.001).
At day 330, 81.8% of patients in the inclisiran first arm achieved LDL goals of < 70 mg/dL, compared to 22.2% in the usual care arm.
At day 330, 71.6% of patients in the inclisiran first arm achieved LDL goals of < 55 mg/dL, compared to 8.9% in the usual care arm.
Only 12.6% of patients in the usual care group received statins in combination with other lipid-lowering therapies, and only 2.5% received a PCSK9 monoclonal antibody without concomitant statins.
Alıntılar
"Results from demonstrate the clinical value of initiating inclisiran earlier in the treatment pathway and highlight the urgent need to improve usual care for US patients with ASCVD."
"We are excited to have this new approach available, which is currently very underutilized but can have such an important impact."
"We need to do a better job as clinical cardiologists in explaining to patients the urgency of getting their LDL down to target levels."