PCSK9 Antibodies Show Promise in Reducing Coronary Plaque in Statin-Treated Patients

Researchers conducted a comprehensive search of PubMed, Embase, and the Cochrane Library, covering studies from inception to February 1, 2023. They included randomized controlled trials (RCTs) and nonrandomized studies that explored the relationship between PCSK9 antibodies and coronary plaque regression and stabilization, as assessed by intravascular imaging, in CAD patients on statin therapy.

A total of nine studies, comprising seven RCTs and two non-RCTs, involving 2290 CAD patients were identified and included in the analysis.

• IVUS-Derived Percent Atheroma Volume (PAV): In statin-treated CAD patients, the addition of PCSK9 antibodies was associated with a significant reduction in PAV (mean difference [MD], -1.26).

• Total Atheroma Volume (TAV): Similar to PAV, the combination therapy resulted in a reduction in TAV (MD, -7.23).

• Incidence of PAV Regression: The addition of PCSK9 antibodies increased the odds of PAV regression (odds ratio [OR], 2.24).

• Incidence of TAV Regression: Patients receiving both PCSK9 antibodies and statins had a higher chance of TAV regression (OR, 1.66).

• OCT-Derived Minimum Fibrous Cap Thickness (FCT): In this aspect, the combination therapy led to a notable increase in FCT (MD, 25.16).

• Incidence of Thin-Capped Fibroatheroma (TCFA) Regression: The odds of TCFA regression were also significantly higher with PCSK9 antibody treatment (OR, 2.56).

• Maximum Lipid Arc: The combination therapy resulted in a decrease in the maximum lipid arc (MD, -14.96).

Interestingly, these positive effects were predominantly observed in Caucasian patients from multiple countries. However, further research is needed to assess the impact of PCSK9 antibodies on Asian patients with CAD.

In conclusion, the meta-analysis suggests that the addition of PCSK9 antibodies to statin therapy can lead to significant regression and stabilization of coronary plaque in CAD patients, particularly in the Caucasian population. These findings highlight the potential of PCSK9 antibodies as a valuable treatment option for CAD, though further investigations are required to determine their efficacy in Asian patients.

Reference:

Sen Liu ,Peijian Wang, Cheng Liu ,Menglong Jin,Jindong Wan,Jixin Hou,Yi Yang,Dan Wang,Ziyang Liu,Zhenyan Fu Effect of PCSK9 antibodies on coronary plaque regression and stabilization derived from intravascular imaging in patients with coronary artery disease: A meta-analysis.