Add-on alirocumab reduces coronary plaque burden in patients with familial hypercholesterolemia

In the treatment of patients with familial hypercholesterolemia, adding alirocumab to high-intensity statin therapy leads to a significant reduction in plaque burden and plaque stabilization, according to data from the ARCHITECT* study.

The phase IV, open-label, multicentre, single-arm trial included 104 patients (median age 53.3 years, 51.9 percent women) with familial hypercholesterolemia without clinical atherosclerotic cardiovascular disease, who were receiving stable treatment with maximum tolerated statin dose with or without ezetimibe. These patients received 150 mg of alirocumab subcutaneously every 14 days in addition to high-intensity statin therapy.

The primary endpoint was the change in coronary plaque burden and its characteristics, as assessed by coronary computed tomographic angiography. All patients underwent an initial coronary computed tomographic angiography at baseline and another at 78 weeks.

Median low-density lipoprotein cholesterol significantly decreased from 138.9 mg/dL at baseline to 45.0 mg/dL at follow-up (p<0.001). The same was true for coronary plaque burden, which changed from 34.6 percent at baseline to 30.4 percent at follow-up (p<0.001).

After treatment, there was a significant increase in the proportion of calcified (0.3 percent; p<0.001) and mainly fibrous (6.2 percent; p<0.001) plaque, with a parallel decrease in the percentage of fibro-fatty (–3.9 percent; p<0.001) and necrotic plaque (–0.6 percent; p<0.001).

*Effect of Alirocumab on Atherosclerotic Plaque Volume, Architecture and Composition