Alirocumab may cause scleritis with uveal effusion in susceptible patients
Alirocumab has been linked to scleritis with uveal effusion in patient with autoimmune diseases according to a case study. In the literature alirocumab has not been reported to cause scleritis.
Alirocumab is a human monoclonal antibody that belongs to a novel class of drugs known as proprotein convertase subtilisin/kexin type 9 inhibitors that increase the expression of low-density lipoprotein receptor and decrease levels of low-density lipoprotein cholesterol . It is used in adults whose high cholesterol is not controlled by diet and statin treatment.
Alirocumab, a newer PCSK9 inhibitor used as a second-line treatment for adults with uncontrolled hypercholesterolemia, may trigger pathologic inflammation including scleritis in susceptible patients. A case report is published in Annals of Internal Medicine.
Clinicians at Columbia University Irving Medical Center, New York-Presbyterian Hospital report the case of a 63-year-old woman who had several weeks of increasing pain, redness, and loss of vision in her right eye that did not resolve with steroid treatment. The patient had a history of Hashimoto thyroiditis and Ménière disease and had been taking an oral statin for hypercholesterolemia, but started alirocumab treatment about 6 weeks before the eye symptoms began. Suspecting a rare reaction from the alirocumab, the clinicians discontinued the medication and treated the patient's scleritis with uveal effusion with prednisone. Within 1 week, the patient reported dramatic improvement in her ocular and systemic symptoms. By 2 months, all of her symptoms and findings had completely resolved. Alirocumab treatment was not resumed.
According to the authors, newer PCSK9 inhibitors will likely bring significant health benefits to many people; however, because they are monoclonal antibodies with immune system interactions, they may also trigger pathologic inflammation in a subset of susceptible patients. Physicians should be on the lookout for idiosyncratic inflammatory responses to these monoclonal antibodies and continue to take good histories to uncover possible links.
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