Evinacumab (Regeneron) is a monoclonal antibody that inhibits angiopoietin-like 3 inhibitor (ANGPTL3). ANGPTL3 is expressed naturally in the liver and acts as a partial inhibitor of lipoprotein lipase and endothelial lipase. Evinacumab’s mechanism of action involves accelerated hydrolysis of very low-density lipoprotein (VLDL) particles by lipoprotein lipase and upregulation of VLDL-remnant clearance pathways, leading to increased apolipoprotein-B-containing lipoprotein clearance before reaching the size of LDL. This may be why it can still lower LDL-C in homozygous familial hypercholesterolemia patients with no residual LDL receptor function. Evinacumab also diminishes endothelial lipase inhibition, which leads to lowered high-density lipoprotein cholesterol, the consequences of which are unclear.
LIST OF FIGURES
7 Figure 1: Comparison of LDL-C lowering in HoFH patients
11 Figure 2: Datamonitor Healthcare’s drug assessment summary of evinacumab for dyslipidemia
12 Figure 3: Datamonitor Healthcare’s drug assessment summary of evinacumab for dyslipidemia
14 Figure 4: Evinacumab sales for dyslipidemia across the US, Japan, and five major EU markets, by country, 2018–27
LIST OF TABLES
6 Table 1: Evinacumab drug profile
7 Table 2: Evinacumab, lipid parameters
8 Table 3: Evinacumab, changes in lipid parameters
9 Table 4: Clinical trials for evinacumab in dyslipidemia
10 Table 5: Evinacumab for dyslipidemia – SWOT analysis
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