Statins are the mainstay of treatment for LDL lowering , however, some patients cannot tolerate statins because of statin-associated muscle symptoms. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) are alternative treatments for them. The purpose of this meta-analysis is to compare LDL reduction with PCSK9 inhibitors and ezetimibe in eligible patients for LDL lowering, not on statins. PUBMED and EMBASE were searched until March 2020 for randomized trials (RCTs) assessing the efficacy of ezetimibe and PCSK9 inhibitors in patients without background statin therapy. The primary outcome was reduction in LDL-C levels. A subgroup analysis of statin intolerant patients was performed. We identified 8 eligible studies of RCTs that enrolled a total of 1602 patients comparing the two pharmacotherapies. PCSK9 inhibitors significantly reduced LDL-C levels compared with ezetimibe (Mean difference (MD): -36.5; 95% confidential interval (CI) [-38.3, -34.7, P < 0.00001, I2=4%]. In the statin intolerant subgroup, PCSK9 inhibitors showed significant reduction in LDL-C compared with ezetimibe. (MD: -36.1; 95% confidential interval (CI) [-39.2, -33.1, P < 0.00001, I2=21%]. In conclusion, among patients who are statin intolerant or not receiving statins, PCSK9 inhibitors are associated with significantly lower LDL-C levels. PCSK9 inhibitors might be useful in the prevention and treatment of ASCVD in this particular subset of patients.
No datasets are available for this submission.