Introduction: PCSK9-inhibitors (PCSK9-i) are a new treatment option for patients not reaching their LDL-cholesterol targets. Efficacy and safety is good in study settings, but there is only few data on real world experience. We analyzed data from 146 consecutive patients who received PCSK9-i and participated in an observational study (lipid clinic; monocentric). Methods: Lipid profiles were obtained (age 63 ± 10 y, BMI 23.6 ± 4.1 kg/m2, 49% male) before and after 3-4 months treatment with PCSK9-i. Results: 44% received Evolocumab 140mg and 56% Alirocumab (29% 75mg and 27% 150mg) q 2 weeks. Patients had either (95%) atherosclerotic disease or familial hypercholesterolemia without atherosclerosis (5%). All were on maximally tolerated lipid lowering therapy. Statin intolerance was prominent (complete 44%, partial 25%). Baseline LDL-c was reduced by 50% (table); there was no significant difference between Alirocumab and Evolocumab. 17 (12%) patients had a LDL-c reduction of <30%. In 8 lipid lowering therapy was reduced, in 4 (2.7%) no reason was detectable, 3 varied considerably with stronger reductions at earlier or later time points. In 2 injection was longer than 2 weeks ago. Treatment was tolerated well. No patient stopped PCSK9-i within the first 3 months. Conclusions: Alirocumab and Evolocumab reduce lipids safely in routine clinical practice. Statin intolerance is one of the main reasons to initiate PCSK9-inhibitors. True non-responders are rare (<3%). Baseline LDL-C is considerably higher than in outcome studies (161 mg/dl vs. 90mg/dl). Whether this translates into even greater clinical benefit than in the studies remains to be evaluated.
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