Impact of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors on Lipoprotein(a)): A Meta-Analysis and Meta-Regression of Randomized Controlled Trials
Authors' conclusion
PCSK9is reduce Lp(a) levels by an average of 27%. Mean percent change in low-density lipoprotein cholesterol and apolipoprotein B were associated with treatment effect.
Study context
- Population
- Trials comparing monoclonal antibody PCSK9is vs placebo on plasma Lp(a) levels
- Comparison
- PCSK9i vs placebo on Lp levels
- Outcome
- Percent change in Lp(a) levels
Methodological detailsmeta-regression analysis, subgroup analyses
- Meta-regression analysis
- Subgroup analyses
Pooled result
As reported in the abstract
PCSK9i reduced Lp(a) levels on average
−27%
95% CI −29.8% to −24.1%P < 0.001
Further pooled results
Meta-regression: factors associated with treatment effect
- Mean percent change in low-density lipoprotein cholesterol
- P = 0.003, beta coefficient 0.34, 95% CI: 0.11-0.57, tau2 = 94.8, R2 = 11.82
- Apolipoprotein B
- P < 0.002, beta coefficient 0.4, 95% CI: 0.14-0.64, tau2 = 93.68, R2 = 11.86
Lp(a) percent change by comparator (subgroup)
- vs placebo
- −27.69% (95% CI: −30.85% to −24.54%, P < 0.001)
- vs ezetimibe
- −24.0% (95% CI: −29.95% to −18.01%, P < 0.001)
- Consistent treatment effect
Lp(a) percent change by type of PCSK9i (subgroup)
- Evolocumab
- −29.35% (95% CI: −33.56% to −25.14%, P < 0.001)
- Alirocumab
- −24.50% (95% CI: −27.96% to −21.04%, P < 0.001)
- Consistent treatment effect
Lp(a) percent change by familial hypercholesterolemia (subgroup)
- Familial hypercholesterolemia
- −25.63% (95% CI: −31.96% to −19.30%, P < 0.001
- No familial hypercholesterolemia
- −27.22%; 95% CI: −30.34% to −24.09%, P < 0.001
- Consistent treatment effect
Lp(a) percent change by duration of treatment (subgroup)
- 12 weeks or shorter
- −32.43% [95% CI: −36.63% to −28.23%
- >12 weeks
- −22.31%] [95% CI: −25.13% to −19.49%, P < 0.001]
- Varying treatment effects
- P interaction < 0.01
Original publication
Impact of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors on Lipoprotein(a)): A Meta-Analysis and Meta-Regression of Randomized Controlled Trials. JACC Adv. Published 10 January 2025. doi:10.
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