The efficacy and safety of evinacumab for the treatment of hypercholesterolemia: a meta-analysis.

Abstract

ABSTRACT\nAngiopoietin-like protein 3 (ANGPTL3) is essential in lipid metabolism regulation. However, the efficacy and safety of evinacumab (ANGPTL3 inhibition drug) for hypercholesterolemia treatment is unknown. In this study, a meta-analysis of randomized controlled trials (RCTs) was conducted to assess the efficacy and safety of evinacumab. RCTs published between January 1, 2000, and November 1, 2020, were obtained from Pubmed, Embase, Cochrane library. All RCTs evaluating the efficacy and safety of evinacumab were included without language restrictions. Our primary endpoints included the percent change of low-density lipoprotein cholesterol (LDL-C) from baseline, and the incidence of at least one treatment emergent adverse events (TEAEs) including nasopharyngitis, influenza-like illness, headache, dizziness, injection-site reaction, increased aspartate aminotransferase, increased alanine aminotransferase, and any other discomfort during treatments. Percentage changes of triglycerides and high-density lipoprotein cholesterol (HDL-C) from baseline indicated secondary endpoints. A random-effects model was used to assess pooled data if there was moderate to high heterogeneity between studies. Four studies with five RCTs (568 participants) were identified. Evinacumab significantly reduced LDL-C (MD -33.123%, 95% CI -48.639% to -17.606%, P<0.0001), triglycerides (MD -50.959%, 95% CI -56.555% to -45.362%, P<0.0001), HDL-C (MD -12.773%, 95% CI -16.359% to -9.186%, P<0.0001) compared with placebo. The incidence of at least 1 TEAEs was not significantly different between evinacumab and placebo groups (RR 1.080, 95% CI 0.901 to 1.296, P=0.405). Evinacumab decreased triglycerides, LDL-C, and HDL-C without significant adverse effects, indicating that it can be a therapeutic strategy for hypercholesterolemia.