4.7 Review

Inclisiran-A Revolutionary Addition to a Cholesterol-Lowering Therapy

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Article Cardiac & Cardiovascular Systems

Inclisiran and cardiovascular events: a patient-level analysis of phase III trials

Kausik K. Ray et al.

Summary: Exploratory findings from the ORION trials suggest that treatment with inclisiran is associated with reductions in major cardiovascular events, providing potential cardiovascular benefits.

EUROPEAN HEART JOURNAL (2023)

Article Endocrinology & Metabolism

Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial

Kausik K. Ray et al.

Summary: This study aimed to assess the long-term effect of inclisiran on patients with high cardiovascular risk and elevated LDL cholesterol. The results showed that twice-yearly treatment with inclisiran resulted in sustained reductions in LDL cholesterol and was well tolerated over 4 years.

LANCET DIABETES & ENDOCRINOLOGY (2023)

Review Pharmacology & Pharmacy

Monoclonal Antibodies, Gene Silencing and Gene Editing (CRISPR) Therapies for the Treatment of Hyperlipidemia-The Future Is Here

Melody Hermel et al.

Summary: This article provides an update on the use of monoclonal antibodies, gene silencing therapies, and gene editing techniques for the management of hyperlipidemia. It reviews the cutting-edge pharmaceuticals targeting LDL cholesterol, PCSK9, lipoprotein (a), angiopoietin-like 3, and apolipoprotein C3. The available and upcoming biotechnological lipid therapies are discussed for clinicians managing patients with familial hyperlipidemia, statin intolerance, hypertriglyceridemia, or elevated lipoprotein (a) levels.

PHARMACEUTICS (2023)

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New Therapeutic Approaches to the Treatment of Dyslipidemia 2: LDL-C and Lp(a)

Kyung An Kim et al.

Journal of Lipid and Atherosclerosis (2023)

Review Pharmacology & Pharmacy

Small interfering RNA: Discovery, pharmacology and clinical development-An introductory review

Priyanga Ranasinghe et al.

Summary: Post-transcriptional gene silencing can be achieved through siRNA therapy, which uses synthetic short double-stranded RNA molecules to specifically target and degrade mRNA transcripts. This technology offers advantages such as broad targeting capabilities and long-lasting effects. However, challenges in terms of pharmacokinetics and pharmacodynamics have been addressed through chemical modification and delivery systems. Several siRNA therapies have been approved for clinical use, but further advancements are needed to target organs beyond the liver and reach special sites.

BRITISH JOURNAL OF PHARMACOLOGY (2023)

Review Medicine, General & Internal

Effectiveness and safety of Inclisiran in hyperlipidemia treatment: An overview of systematic reviews

Jiayi Li et al.

Summary: This study comprehensively evaluated the effectiveness and safety of Inclisiran in treating hyperlipidemia through systematic reviews. The results showed that 300mg Inclisiran with 2 injections a year had the best therapeutic effect, significantly reducing low-density lipoprotein cholesterol and total cholesterol, and increasing high-density lipoprotein cholesterol levels. Inclisiran had a favorable safety profile, with no significant difference in adverse reaction incidence compared to a placebo.

MEDICINE (2023)

Article Pharmacology & Pharmacy

Inclisiran: a small interfering RNA strategy targeting PCSK9 to treat hypercholesterolemia

Yajnavalka Banerjee et al.

Summary: Inclisiran is a novel therapy that silences PCSK9 synthesis through RNA interference, effectively reducing LDL-C levels and lowering the risk for cardiovascular events. Clinical trials have shown its safety and efficacy, with injection-site reactions being more common than in the placebo group. Further studies are needed to ensure its specificity in targeting PCSK9 without affecting other physiological mRNAs.

EXPERT OPINION ON DRUG SAFETY (2022)

Review Cardiac & Cardiovascular Systems

Major adverse cardiovascular events in homozygous familial hypercholesterolaemia: a systematic review and meta-analysis

Adam Kramer et al.

Summary: This study aimed to assess the prevalence and age-of-onset of major adverse cardiovascular events (MACE) among patients with Homozygous Familial Hypercholesterolaemia (HoFH). The findings showed that atherosclerotic cardiovascular disease is common among HoFH patients and occurs at a young age. The age-of-onset of myocardial infarction was delayed by more than a decade from pre-1990 to post-1990, reflecting substantial progress in the management of this rare but severe disorder.

EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY (2022)

Review Cardiac & Cardiovascular Systems

Existing and emerging strategies to lower Lipoprotein(a)

Gregory G. Schwartz et al.

Summary: Elevated levels of lipoprotein(a) are linked to higher cardiovascular risk, and current therapeutic options for reducing lipoprotein(a) levels are limited. PCSK9 inhibitors and lipoprotein apheresis are the only effective methods to lower lipoprotein(a) and reduce cardiovascular risk.

ATHEROSCLEROSIS (2022)

Review Pharmacology & Pharmacy

Inclisiran: A Novel Small Interfering RNA Drug for Low-Density Lipoprotein Reduction

Kimberly W. Smith et al.

Summary: Inclisiran, a novel small interfering RNA molecule, increases the expression of low-density lipoprotein surface receptors on hepatocytes, leading to a reduction in low-density lipoprotein. It is indicated for patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease. Compared to other options, Inclisiran has a convenient dosing protocol and a favorable safety profile.

JOURNAL OF CLINICAL PHARMACOLOGY (2022)

Review Peripheral Vascular Disease

Inclisiran: How Widely and When Should We Use It?

Angela Pirillo et al.

Summary: In this review, the efficacy and safety of inclisiran, a siRNA targeting PCSK9, in reducing LDL-C levels is discussed. Randomized clinical trials have shown that inclisiran provides durable reductions of PCSK9 and LDL-C levels, with a dosing schedule of once every 6 months. These effects are consistent in different categories of patients, and the drug's safety profile is favorable.

CURRENT ATHEROSCLEROSIS REPORTS (2022)

Review Pharmacology & Pharmacy

Small interfering ribonucleic acid for cholesterol lowering - Inclisiran

Daniel Soffer et al.

Summary: Despite the development of new therapies, the trend of reductions in cardiovascular disease (CVD) mortality has reversed. Lowering low-density lipoprotein cholesterol (LDL-C) is important for preventing and managing atherosclerotic CVD (ASCVD), but many patients with established ASCVD fail to achieve guideline-recommended LDL-C targets.

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Article Medicine, General & Internal

Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial

Byeong-Keuk Kim et al.

Summary: Through a randomized trial, it was found that the combination therapy of moderate-intensity statin and ezetimibe is as effective as high-intensity statin monotherapy in reducing cardiovascular events and maintaining stable LDL cholesterol concentrations, with better drug tolerance.

LANCET (2022)

Article Cardiac & Cardiovascular Systems

Long-Term Evolocumab in Patients With Established Atherosclerotic Cardiovascular Disease

Michelle L. O'Donoghue et al.

Summary: Long-term use of evolocumab to lower LDL-C levels is associated with low rates of adverse events, which do not exceed those in the placebo group. Over time, the use of evolocumab also leads to further reduction in cardiovascular events.

CIRCULATION (2022)

Review Cardiac & Cardiovascular Systems

PCSK9 Inhibitor Wars: How Does Inclisiran Fit in with Current Monoclonal Antibody Inhibitor Therapy? Considerations for Patient Selection

Natalie Arnold et al.

Summary: This review critically summarizes the emerging cholesterol-lowering therapy targeting PCSK9, with a focus on the use of anti-PCSK9 monoclonal antibodies (mAbs) and inclisiran. Although both drug classes show similar efficacy in reducing LDL-C levels, the long-term safety and CV outcomes of inclisiran are still unknown.

CURRENT CARDIOLOGY REPORTS (2022)

Review Cell Biology

PCSK9 Inhibition: From Current Advances to Evolving Future

Chunping Liu et al.

Summary: This article summarizes the application, preclinical studies, safety, mechanism of action, and latest research progress of PCSK9 inhibitors. It aims to provide ideas for drug research and development, as well as expand the application of PCSK9 inhibitors in other diseases.
Article Cardiac & Cardiovascular Systems

Efficacy and Safety of Inclisiran in Patients with Polyvascular Disease: Pooled, Post Hoc Analysis of the ORION-9, ORION-10, and ORION-11 Phase 3 Randomized Controlled Trials

Wolfgang Koenig et al.

Summary: This study analyzed the lipid-lowering efficacy and safety of inclisiran versus placebo in patients with and without polyvascular disease (PVD). The results showed that twice-yearly inclisiran dosing effectively reduced LDL-C levels and was well tolerated in patients, irrespective of PVD status.

CARDIOVASCULAR DRUGS AND THERAPY (2022)

Review Cardiac & Cardiovascular Systems

A Comprehensive Review of PCSK9 Inhibitors

Caroline Coppinger et al.

Summary: Cardiovascular disease is a leading cause of death globally, and high levels of LDL-C are a major risk factor. PCSK9 inhibitors have been found to significantly reduce LDL-C levels and lower the occurrence of major adverse cardiovascular events in high-risk patients. They can be used in populations who are intolerant to statins or do not achieve their treatment goals.

JOURNAL OF CARDIOVASCULAR PHARMACOLOGY AND THERAPEUTICS (2022)

Article Cardiac & Cardiovascular Systems

Why patients with familial hypercholesterolemia are at high cardiovascular risk? Beyond LDL-C levels * , **

Vanessa Bianconi et al.

Summary: Familial hypercholesterolemia (FH) is a common genetic disorder characterized by elevated LDL-C levels due to defective clearance of LDL particles, leading to increased risk of premature cardiovascular disease. Besides LDL-C, other CVD risk factors may also contribute to the overall CVD risk burden in FH patients.

TRENDS IN CARDIOVASCULAR MEDICINE (2021)

Review Pharmacology & Pharmacy

The growth of siRNA-based therapeutics: Updated clinical studies

M. May Zhang et al.

Summary: After more than twenty years since the discovery of the natural gene-silencing mechanism of RNA interference, siRNA-based therapeutics have entered the pharmaceutical market with three approved drugs and many others in advanced stages of development. The majority of late-stage candidates are targeted towards rare diseases or patients who have not responded to current treatments, while some have potential for a wider patient population. This review provides an overview of siRNA mechanisms, barriers to delivery, and profiles of approved drugs and candidates in Phase 3 clinical trials.

BIOCHEMICAL PHARMACOLOGY (2021)

Article Pharmacology & Pharmacy

Inclisiran: First Approval

Yvette N. Lamb

Summary: Inclisiran is a first-in-class cholesterol-lowering drug administered through subcutaneous injection, approved for use in patients with primary hypercholesterolaemia or mixed dyslipidaemia.
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Inclisiran A Game Changer in a Changing Game?

Vijay Nambi et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2021)

Article Biochemistry & Molecular Biology

CRISPR Gene Editing in Lipid Disorders and Atherosclerosis: Mechanisms and Opportunities

Harry E. Walker et al.

Summary: Elevated LDL-C is causally associated with atherosclerotic cardiovascular disease, and advancements in reducing LDL-C through statins and PCSK9 drugs have been made. However, approaches targeting PCSK9 need further improvement, and CRISPR gene-editing shows promise as a tool for lifelong LDL-C reduction.

METABOLITES (2021)

Review Cardiac & Cardiovascular Systems

Regulation of PCSK9 Expression and Function: Mechanisms and Therapeutic Implications

Xiao-dan Xia et al.

Summary: PCSK9 plays a vital role in promoting cardiovascular disease and cancer by degrading LDLR and affecting tumor growth. Inhibition of PCSK9 can reduce the risk of cardiovascular disease and cancer.

FRONTIERS IN CARDIOVASCULAR MEDICINE (2021)

Article Cell Biology

An oral antisense oligonucleotide for PCSK9 inhibition

Peter Gennemark et al.

Summary: In this study, a chemically modified PCSK9 antisense oligonucleotide (ASO) with potential for oral delivery was developed and shown to effectively reduce LDL cholesterol levels. Animal experiments demonstrated liver targeting and significant reductions in PCSK9 and LDL cholesterol levels after oral administration.

SCIENCE TRANSLATIONAL MEDICINE (2021)

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Hydrophilic or Lipophilic Statins?

Elisenda Climent et al.

Summary: Statins can be classified as hydrophilic or lipophilic, with different solubility profiles potentially impacting cardiovascular outcomes and adverse effects. The superiority of one type of statin over another in terms of solubility remains uncertain, with conflicting results observed in previous studies on cardiovascular and heart failure outcomes.

FRONTIERS IN CARDIOVASCULAR MEDICINE (2021)

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Amirhossein Sahebkar et al.

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siRNA: Mechanism of action, challenges, and therapeutic approaches

Walhan Alshaer et al.

Summary: siRNA functions in gene silencing and targets disease-related genes, yet it faces issues such as low cellular uptake and susceptibility to degradation, requiring a carrier for protection and delivery.

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Insights into the kinetics and dynamics of the furin-cleaved form of PCSK9

Carlota Oleaga et al.

Summary: Our study confirms that PCSK9_55 is predominantly formed extracellularly with a shorter half-life, while a small intracellular pool of PCSK9_55 remains non-secreted. Intracellularly retained PCSK9_55 exhibits reduced efficiency in inducing LDLR degradation compared to PCSK9_62.

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Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia

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Larysa Strilchuck et al.

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Lukasz Buldak et al.

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Valentin Blanchard et al.

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