August 2015
Following the approval of the first PCSK9 Inhibitor, Praluent (SNY, REGN), this 5- question survey of 23 cardiologists evaluated attitudes towards the class, projected usage prior to their CVOTs depending on insurance prior authorization, preference of Praluent vs Repatha (AMGN), and how the oral CETP inhibitors would impact PCSK9 usage under different outcomes study scenarios.
Tables of contents
Question 1: Of your secondary prevention patients, that is those with clinical atherosclerotic cardiovascular (ASCVD) disease, what percent have LDL-c above the following levels?
Question 2: PCSK9 inhibitors are injected every 2-4 weeks (Q2W, Q4W) and lower LDL-c by 44-64%. Safety has been good so far, but long term effects of very low LDL-c levels in a subgroup are unknown. CV outcomes trial (CVOT) data is expected late 2017, but for now they are approved for clinical ASCVD in patients on a maximally tolerated statin.
Question 3: New oral drugs may compete with the PCSK9 inhibitors. The CETP inhibitors reduce LDL-c by 25-40% and increase HDL-c by 100-180%, though the benefit of the latter is not clear. Assume the oral CETP inhibitors and the injected PCSK9 inhibitors are shown to be safe in their CVOTs.