MO972: Impact of Inhibition of Pcsk-9 Among Renal Transplant Recipients with High Cardiovascular Risk. (3rd May 2022) - Alotaibi, Torki
Abstract: BACKGROUND AND AIMS: Monoclonal antibodies inhibiting proprotein convertase subtilisin/Kexin type A(PCSK-9) have emerged as one of the new cholesterol-lowering agents. It is not evaluated among renal transplant recipients despite its favorable safety profile. We aimed to evaluate the safety and efficacy of evolocumab in reducing lipids and cardiovascular events among risky renal transplant recipients. METHOD: About 195 kidney transplant recipients—with high cardiovascular risk (>20)—were enrolled in this randomized controlled study during the period between 6.2017 and 6.2018. Patients who received statin and evolocumab (140 mg/2 weeks, group 1, n = 97) while those who were maintained on statin alone comprised group 2 ( n = 98). They were followed up for 24 months. RESULTS: The two groups were comparable regarding their demographics (P > 0.05). Before enrollment in the study, post-transplant complications were comparable apart from a higher prevalence of NODAT in group 2 (P = 0.033). Smokers were significantly more prevalent in group 1. Basal graft function was significantly higher in group 1 despite equivalent regimen of immunosuppression in both groups (P > 0.05). Clinically two groups were comparable concerning cardiovascular events and both graft and patient outcomes (P > 0.05). Basal cholesterol was significantly higher in group 1 (5.5 versus 4.7, P < 0.001) which dropped significantly after 3 months (versus12 months in group 2) and thereafter (P = 0.031). We observed that triglycerides in the two groups were comparable (P > 0.05) till the end of the study. CONCLUSION: Evolocumab is a promising add on lipid-lowering agent. In high risk renal transplant, earlier reduction of cholesterol was observed in the add-on evolocumab group but without significant positive cardiovascular impact.