PCSK9-Inhibitors: High Price to Pay for Improved Cardiac Outcomes

Monoclonal antibody inhibitors of proprotein convertase subtilisin/kexin 9 (PCSK9), when added to statin therapy, lower cholesterol levels and prevent some adverse cardiac events and deaths, according to two trials (NEJM JW Gen Med Jan 1 2019 and N Engl J Med 2018; 379:2097; NEJM JW Gen Med May 1 2017 and N Engl J Med 2017; 376:1713). Number needed to treat is ≈20 to prevent 1 death during ≈3 years; however, the high cost of PCSK9 inhibitors has discouraged broad use. Using data (from one of the studies) on >20,000 patients with recent initial myocardial infarctions, investigators compared the cost-effectiveness of alirocumab (Praluent), added to maximally tolerated statin therapy, with statin therapy alone or with statin therapy plus ezeti…