2022台灣血脂治療指引(英文版)下面中文使用google自動翻譯
PCSK9抑制劑用於一級預防
PCSK9 與肝細胞表面的低密度脂蛋白受體 (LDL-R) 結合，導致受體降解並降低 LDL-R 的再利用率。 PCSK9 抗體可幹擾其與 LDL-R 的結合，進而導致肝臟 LDL-R 表現升高和血漿 LDL-C 水準降低。 <sup>110</sup> 對於需要額外降低 LDL-C 水平的家族性高膽固醇血症 (FH) 或動脈粥狀硬化性心血管疾病 (ASCVD) 患者，可使用 PCSK9 抑制劑，例如依洛尤單抗或阿利西尤單抗，以達到最大耐受劑量的他汀類藥物治療。一項統合分析證實，PCSK9 抑制劑對那些可能不適合其他降血脂藥物或無法透過傳統療法達到血脂目標的患者有效。 <sup>111</sup> 目前大多數 PCSK9 抑制劑研究優先納入已確診 ASCVD、FH 或高風險患者。 PCSK9 抑制劑在低危險群至中危險群的療效證據有限。
推薦
對於使用高強度或最大耐受劑量他汀類藥物和依折麥布仍無法達到 LDL-C 目標值的高風險患者，可考慮使用 PCSK9 抑制劑進行一級預防。 （COR IIa，LOE B）
PCSK9 inhibitors for primary prevention
PCSK9 binds to LDL receptor (LDL-R) on the surface of hepatocytes leading to degradation of the receptors and decreasing the reuse of LDL-R. Antibodies to PCSK9 interfere its binding with the LDL-R resulting in higher hepatic LDL-R expression and lower plasma LDL-C levels.110 PCSK9 inhibitors, such as evolocumab or alirocumab, could be used in patients with FH or ASCVD who require additional LDL-C lowering in addition to maximally tolerated statins. One meta-analysis demonstrated the efficacy of PCSK9 inhibitors in those who might not be eligible for other lipidlowering drugs or who cannot meet their lipid goals on the traditional therapies.111 Most of the available studies of PCSK9 inhibitors preferentially enrolled patients with either established ASCVD, FH or at high risk. The evidence of PCSK9 inhibitors in those with low to moderate risk settings is minimal.
Recommendation
PCSK9 inhibitors can be considered for primary prevention in patients at high risk who cannot achieve LDL-C target with high-intensity or maximal tolerated statins and ezetimibe. (COR IIa, LOE B)
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