Effect of Alirocumab Monotherapy vs Ezetimibe Plus Statin Therapy on LDL-C Lowering in Veterans With History of ASCVD.

Background: Guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal of < 70 mg/dL for patients with very high-risk atherosclerotic cardiovascular disease (ASCVD). While alirocumab monotherapy and ezetimibe plus statin therapy have both shown efficacy in independently reducing LDL-C, a direct comparison has not been conducted.

Methods: A retrospective chart review at the Veterans Affairs Sioux Falls Health Care System compared 20 patients with a history of ASCVD events who received alirocumab monotherapy to 60 patients receiving ezetimibe plus statin therapy. The primary endpoint was incidence of reaching the < 70 mg/dL LDL-C goal after 4 to 12 weeks, 13 to 24 weeks, and 25 to 52 weeks.

Results: Fourteen patients (70%) in the alirocumab monotherapy group reached the LDL-C goal (< 70 mg/dL) compared with 34 patients (57%) in the ezetimibe plus statin group (P = .29). In both groups, the goal was most frequently achieved in 25 to 52 weeks.

Conclusions: In a small population of veterans with ASCVD, there was no significant difference between the 2 treatment groups in LDL-C reduction or in several secondary endpoints, including percentage change in high-density lipoprotein and triglycerides, ASCVD events, and adverse events leading to treatment discontinuation. However, a statistically significant difference in percentage reduction in LDL-C and total cholesterol was found favoring alirocumab monotherapy.