Q. I am a 50 year old woman. I have recently been advised by my doctor to start the new cholesterol lowering drug ALIROCUMAB. I am already using maximum dose of lipitor (ATORVASTATIN) but it has not lead to any significant lowering of my cholesterol. In fact, i have gained weight significantly in the past 2 years. My current LDL level is above 200 with these drugs. Would it be advisable to use this new product ? What is the cost of ALIROCUMAB ? Is it cost effective ?

Ans.

Hello and Welcome to AskHealthMD

I appreciate your concern. I want you to read these points carefully as they will give you the essential guidance required to make this decision. I hope it is helpful to you.

  • ALIROCUMAB is a monoclonal antibody. It is a PCSK9 inhibitor which has been approved for clinical use by the FDA in 2015. 
  • PCSK9 is found on the liver and is a protein which was discovered not even a decade ago. If this protein is bound by the drug then the receptor it controls , stays longer in the liver ,retarding its recycling and the receptor is able to free the body of excess cholesterol more efficiently.
  • If diet modification and maximum statin therapy does not lead to significant or desired lowering in Low-density lipoprotein-cholesterol then ALIROCUMAB is a viable option in such individuals.
  • In patients with Heterozygous familial hypercholesterolemia and / or clinically evident Atherosclerotic cardiovascular disease who require LDL-C lowering and is not being achieved by conventional statin therapy , its use is recommended. 
  • The PCSK9 inhibitors use is now being extended to patients with Homozygous familial hypercholesterolemia
  • The adverse effects associated with statins such as liver dysfunction and rhabdomyolysis are not found with ALIROCUMAB. It does cause myalgia and flu like illness but that too in a very small subset of patients. So, its adverse effect profile is much better than the statins.
  • It is administered as a subcutaneous injection. The starting dose is one injection 75 mg SC every 2 weeks. It can be given on a 4 week regimen too. Its dose can then be 300 mg every month. 
  • The average cost of  Alirocumab is $14,350 per patient for a one-year supply or approximately $1200 per month. So you can see its not very cost effective like the statins or other cholesterol lowering drugs. You should , however, definitely go for it if you can afford it.
  • In addition to Praulent (ALIROCUMAB) , you should also focus on some lifestyle changes to have a better chance at preventing the complications associated with a deranged lipid profile.
  • Lower or Stop the intake of saturated fat contained in red meat, butter, deep fried food , fast food/ junk food. Increase intake of foods rich in omega 3 fatty acids e.g seafood like fish
  • Increase physical activity with regular aerobic exercise. Decrease caloric count and continue vigorous exercise with regular coffee intake to help speed up the metabolic rate and shed some weight. These interventions would reduce your reliance on drugs to a great deal.
  • One thing which the FDA specifically withheld as an indication , was Statin intolerance. Its a complex term and may lead to many patients abandoning statins for the good. This was a signal they gave to reserve this drug specifically for those in whom the cardiovascular risk is high and whose response to optimum therapy was poor.

 

Wishing you best of health

Thanks

Dr. Muhammad Sareer Khalil