nav emailalert searchbtn searchbox tablepage yinyongbenwen piczone journalimg journalInfo journalinfonormal searchdiv searchzone qikanlogo popupnotification paper paperNew
2025, 06, v.34 470-475
PCSK9单克隆抗体在动脉粥样硬化性心血管疾病治疗中的研究进展
基金项目(Foundation): 中华医学会临床药学分会2023年度临床药学科研基金项目(编号Z-2021-46-2101-2023)
邮箱(Email):
DOI: 10.19577/j.1007-4406.2025.06.014
摘要:

动脉粥样硬化性心血管疾病(ASCVD)的防治是我国卫生健康事业的一项重要内容,积极采取降脂治疗可有效地降低我国急性心肌梗死、卒中死亡率,减少医疗支出。前蛋白转化酶枯草溶菌素9(PCSK9)单克隆抗体是一种新型非他汀类降脂药物,可在原有他汀治疗基础上显著降低低密度脂蛋白胆固醇(LDL-C)水平50%~70%。然而,PCSK9单克隆抗体治疗后患者出现LDL-C水平过低的安全性仍存在争议。该综述根据现有的PCSK9单克隆抗体的研究数据,着重关注PCSK9单克隆抗体的疗效和安全性,综合评价PCSK9单克隆抗体使用的风险获益和临床用药现状,为临床使用PCSK9单克隆抗体提供循证依据。

Abstract:

Prevention and treatment of atherosclerotic cardiovascular diseases is an important part of health care in China. Positive lipid therapy can effectively reduce the mortality of acute myocardial infarction and stroke and reduce medical expenses in China. Proprotein convertase subtilisin/kexin type 9(PCSK9) monoclonal antibody is a new non-statin drug, which can significantly reduce low-density lipoprotein cholesterol(LDL-C) level by 50%-70% based on the original statin treatment. However, in the treatment of PCSK9 monoclonal antibodies, the safety of patients with low LDL-C levels is still controversial. This review integrates the existing research data of PCSK9 monoclonal antibodies, focuses on the efficacy and safety of PCSK9 monoclonal antibodies, comprehensively evaluates the risk and benefit of PCSK9 monoclonal antibodies, and the current situation of clinical medication, and provides the evidence-based basis for clinical use of PCSK9 monoclonal antibodies.

参考文献

[1]国家卫生和计划生育委员会疾病预防控制局.中国居民营养与慢性病状况报告[R].北京:人民卫生出版社, 2015.

[2] SONG P K, MAN Q Q, LI H, et al. Trends in lipids level and dyslipidemia among Chinese adults, 2002-2015[J]. Biomed Environ Sci, 2019, 32(8):559.

[3]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志, 2016,44(10):833.

[4] GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195countries and territories, 1980-2017:a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2018,392(10159):1736.

[5] ANNEMANS L, STOCK J K, CHAPMAN M J. PCSK9 inhibition,atherosclerotic cardiovascular disease, and health economics:challenges at the crossroads[J]. J Clin Lipidol, 2019, 13(5):714.

[6] GRUNDY S M, STONE N J, BAILEY A L, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol:a report of the American college of cardiology/American heart association task force on clinical practice guidelines[J]. Circulation, 2019,139(25):e1082.

[7] MACH F, BAIGENT C, CATAPANO A L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias:lipid modification to reduce cardiovascular risk[J]. Eur Heart J, 2020,41(1):111.

[8] AHAMAD S, MATHEW S, KHAN W A, et al. Development of small-molecule PCSK 9 in hibitors for the treatment of hypercholesterolemia[J]. Drug Discov Today, 2022, 27(5):1332.

[9]薛宇,刘海伟,李洋.前蛋白转换酶枯草溶菌素9抑制剂降低脂蛋白(a)作用的机制[J].生物化学与生物物理进展, 2024, 51(4):850.

[10] HUSSAIN A, BALLANTYNE C M. New approaches for the prevention and treatment of cardiovascular disease:focus on lipoproteins and inflammation[J]. Annu Rev Med, 2021, 72:431.

[11] BAYS H, GAUDET D, WEISS R, et al. Alirocumab as add-on to atorvastatin versus other lipid treatment strategies:ODYSSEY OPTIONS I randomized trial[J]. J Clin Endocrinol Metab, 2015,100(8):3140.

[12] SABATINE M S, GIUGLIANO R P, WIVIOTT S D, et al. Efficacy and safety of evolocumab in reducing lipids and cardiovascular events[J]. N Engl J Med, 2015, 372(16):1500.

[13] HIRAYAMA A, YAMASHITA S, INOMATA H, et al. One-year efficacy and safety of evolocumab in Japanese patients-A pooled analysis from the open-label extension OSLER studies[J]. Circ J,2017, 81(7):1029.

[14] KASICHAYANULA S, GROVER A, EMERY M G, et al. Clinical pharmacokinetics and pharmacodynamics of evolocumab, a PCSK9inhibitor[J]. Clin Pharmacokinet, 2018, 57(7):769.

[15] HIRAYAMA A, HONARPOUR N, YOSHIDA M, et al. Effects of evolocumab(AMG 145), a monoclonal antibody to PCSK9,in hypercholesterolemic, statin-treated Japanese patients at high cardiovascular risk:primary results from the phase 2 YUKAWA study[J]. Circ J, 2014, 78(5):1073.

[16] MURPHY S, O’DONOGHUE M L, WIVIOTT S, et al. Reduction in total cardiovascular events with the pcsk9 inhibitor evolocumab in patients with cardiovascular disease in the combined Fourier and Fourier open-label extension(ole)studies[J]. J Am Coll Cardiol,2023, 81(Suppl 8):1121.

[17] Cholesterol Treatment Trialists’(CTT)Collaboration, BAIGENT C, BLACKWELL L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol:a meta-analysis of data from170, 000 participants in 26 randomised trials[J]. Lancet, 2010,376(9753):1670.

[18] GIUGLIANO R P, PEDERSEN T R, PARK J G, et al. Clinical efficacy and safety of achieving very low LDL-cholesterol concentration swith the PCSK 9 in hibitorevolocum a b:a prespecified secondary analysis of the FOURIER trial[J].Lancet, 2017, 390(10106):1962.

[19] ZHANG Y, SUO Y R, YANG L, et al. Effect of PCSK9 inhibitor on blood lipid levels in patients with high and very-high CVD risk:a systematic review and meta-analysis[J]. Cardiol Res Pract,2022, 2022:8729003.

[20] Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals:a randomised placebo-controlled trial[J].Lancet, 2002, 360(9326):7.

[21] ANDERSON J L, HEIDENREICH P A, BARNETT P G, et al.ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures:a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines[J].Circulation, 2014, 129(22):2329.

[22] MA W R, PAN Q Y, PAN D F, et al. Efficacy and safety of lipidlowering drugs of different intensity on clinical outcomes:a systematic review and network meta-analysis[J]. Front Pharmacol, 2021, 12:713007.

[23] KHAN S U, TALLURI S, RIAZ H, et al. A Bayesian network metaanalysis of PCSK9 inhibitors, statins and ezetimibe with or without statins for cardiovascular outcomes[J]. Eur J Prev Cardiol,2018, 25(8):844.

[24] O’CONNELL E M, LOHOFF F W. Proprotein convertase subtilisin/kexin type 9(PCSK9)in the brain and relevance for neuropsychiatric disorders[J]. Front Neurosci, 2020, 14:609.

[25] BANDYOPADHYAYD, ASHISHK, HAJRAA, et al.Cardiovascular outcomes of PCSK9 inhibitors:with special emphasis on its effect beyond LDL-cholesterol lowering[J]. J Lipids, 2018, 2018:3179201.

[26] KHAN A R, BAVISHI C, RIAZ H, et al. Increased risk of adverse neurocognitive outcomes with proprotein convertase subtilisinkexin type 9 inhibitors[J]. Circ Cardiovasc Qual Outcomes,2017, 10(1):e003153.

[27] SABATINE M S, GIUGLIANO R P, KEECH A C, et al.Evolocumab and clinical outcomes in patients with cardiovascular disease[J]. N Engl J Med, 2017, 376(18):1713.

[28] SCHWARTZ G G, STEG P G, SZAREK M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome[J]. N Engl J Med, 2018, 379(22):2097.

[29] GIUGLIANO R P, MACH F, ZAVITZ K, et al. Cognitive function in a randomized trial of evolocumab[J]. N Engl J Med, 2017,377(7):633.

[30] BAJAJ N S, PATEL N, KALRA R, et al. Neurological effects of proprotein convertase subtilisin/kexin type 9 inhibitors:direct comparisons[J]. Eur Heart J Qual Care Clin Outcomes, 2018, 4(2):132.

[31] HARVEY P D, SABBAGH M N, HARRISON J E, et al. No evidence of neurocognitive adverse events associated with alirocumab treatment in 3340 patients from 14 randomized Phase2 and 3 controlled trials:a meta-analysis of individual patient data[J]. Eur Heart J, 2018, 39(5):374.

[32] ROBINSON J G. Low LDL-C levels:likely No short-term cognitive harm[J]. J Am Coll Cardiol, 2020, 75(18):2294.

[33] DI MAURO G, ZINZI A, SCAVONE C, et al. PCSK9 inhibitors and neurocognitive adverse drug reactions:analysis of individual case safety reports from the eudravigilance database[J]. Drug Saf, 2021, 44(3):337.

[34] BLOM D J, DJEDJOS C S, MONSALVO M L, et al. Effects of evolocumab on vitamin E and steroid hormone levels:results from the 52-week, phase 3, double-blind, randomized, placebocontrolled DESCARTES study[J]. Circ Res, 2015, 117(8):731.

[35] KAWASHIRI M A, NOHARA A, HIGASHIKATA T, et al. Impact of evolocumab treatment on low-density lipoprotein cholesterol levels in heterozygous familial hypercholesterolemic patients withdrawing from regular apheresis[J]. Atherosclerosis, 2017,265:225.

[36] BLOM D J, CHEN J Y, YUAN Z Y, et al. Effects of evolocumab therapy and low LDL-C levels on vitamin E and steroid hormones in Chinese and globalpatients with type 2 diabetes[J].Endocrinol Diabetes Metab, 2020, 3(2):e00123.

[37] KOSMAS C E, SKAVDIS A, SOURLAS A, et al. Safety and tolerability of PCSK9 inhibitors:current insights[J]. Clin Pharmacol, 2020, 12:191.

[38] ZEWINGER S, KLEBER M E, TRAGANTE V, et al. Relations between lipoprotein(a)concentrations, LPA genetic variants, and the risk of mortality in patients with established coronary heart disease:a molecular and genetic association study[J]. Lancet Diabetes Endocrinol, 2017, 5(7):534.

[39] SABATINEMS, LEITERLA, WIVIOTTSD, et al.Cardiovascular safety and efficacy of the PCSK9 inhibitor evolocumab in patients with and without diabetes and the effect of evolocumab on glycaemia and risk of new-onset diabetes:a prespecified analysis of the FOURIER randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2017, 5(12):941.

[40] MONAMI M, SESTI G, MANNUCCI E. PCSK9 inhibitor therapy:a systematic review and meta-analysis of metabolic and cardiovascular outcomes in patients with diabetes[J]. Diabetes Obes Metab, 2019, 21(4):903.

[41] KEECH A C, OYAMA K, SEVER P S, et al. Efficacy and safety of long-term evolocumab use among Asian subjects-A subgroup analysis of the further cardiovascular outcomes research with PCSK9 inhibition in subjects with elevated risk(FOURIER)trial[J]. Circ J, 2021, 85(11):2063.

[42] RAY K K, COLHOUN H M, SZAREK M, et al. Effects of alirocumab on cardiovascular and metabolic outcomes after acute coronary syndrome in patients with or without diabetes:a prespecified analysis of the ODYSSEY OUTCOMES randomised controlled trial[J]. Lancet Diabetes Endocrinol, 2019, 7(8):618.

[43] GRZE?K G, DOROTA B, WO?OWIEC?, et al. Safety of PCSK9inhibitors[J]. Biomed Pharmacother, 2022, 156:113957.

[44] MUNTNER P, GHAZI L, JONES J, et al. Persistence and adherence to PCSK9 inhibitor monoclonal antibodies versus ezetimibe in realworld settings[J]. Adv Ther, 2024, 41(6):2399.

基本信息:

DOI:10.19577/j.1007-4406.2025.06.014

中图分类号:R54

引用信息:

[1]彭文星,张梦迪,林阳.PCSK9单克隆抗体在动脉粥样硬化性心血管疾病治疗中的研究进展[J].中国临床药学杂志,2025,34(06):470-475.DOI:10.19577/j.1007-4406.2025.06.014.

基金信息:

中华医学会临床药学分会2023年度临床药学科研基金项目(编号Z-2021-46-2101-2023)

检 索 高级检索

引用

GB/T 7714-2015 格式引文
MLA格式引文
APA格式引文