Efficacy and safety of different doses of alirocumab in reducing low-density lipoprotein cholesterol levels: a network meta-analysis.

This study aimed to conduct a network meta-analysis of the efficacy and safety of different doses of alirocumab in reducing low-density lipoprotein cholesterol levels. In the present study, a total of 16 studies were selected, published between January 2012 and October 2016. Pair-wise and network meta-analyses was used to carry out a direct and indirect comparison of the three treatment strategies of alirocumab in patients with hypercholesterolemia. The efficacy and safety of these different treatment strategies were analyzed. Results revealed that alirocumab could significantly reduce LDL-c levels, compared with placebo (relative effect 95 % CI: -71.45 [-91.16, -50.44], -74.32 [-90.40, -58.63] and -77.28 [-92.21, -61.90]) and ezetimibe (EZE) (relative effect 95 % CI: -37.2 [-61.21, -12.41], -40.07 [-56.92, -24.22] and -43.00 [-68.39, -17.91]). The comparison of the three treatment strategies of alirocumab indicated no significant differences in reducing the levels of LDL-c, TGs, TC, Lp (a), Apo B and SAEs, LTTD, IST, ACE, MD and NC. For the probabilities of 75 mg, 75-150 mg and 150 mg of alirocumab, the best treatment for EZE and placebo were 50 %, 68 %, 82 %, 1 % and 0 %, according to LDL-c level. The results of the benefit-risk analysis of efficacy and safety revealed that the logarithmic scale was 0.016 for 75 mg vs. 75-150 mg of alirocumab and 0.125 for 75-150 mg vs. 150 mg of alirocumab. The PCSK9 inhibitor alirocumab presents a significantly greater reducing effect on the levels of LDL-c compared with EZE, and the different doses of alirocumab exhibited no significant difference in the efficacy of LDL-c for hypercholesterolemia. An alirocumab dose of 75-150 mg Q2W might be the best choice due to its most favorable balance between efficacy and safety.