腎移植レシピエントの高LDLコレステロール血症に対するPCSK9阻害薬の使用経験

抄録

【Objective】 Lipid metabolism disorder worsens in many patients after kidney transplantation depending on the immunosuppressive agents administered. Thus, this study aimed to examine the safety and efficacy of using monoclonal antibodies that inhibit proprotein convertase subtilisin-kexin type 9 (PCSK9) and have a potent effect on lowering low-density lipoprotein cholesterol (LDL-C) levels in patients who have undergone kidney transplantation.

【Design】 Case series study.

【Methods】 Patients who received PCSK9 inhibitors, Evolocumab or Alirocumab, and had an inadequate control of LDL-C levels despite being under statin therapies were investigated. The data obtained before and after the patients were administered these agents were compared to investigate the LDL-C lowering effects and adverse event occurrences.

【Results】 Of the patients, 11 were treated with PCSK9 inhibitors (8 men and 3 women, median age: 63 years; interquartile range [IQR] 59-68). A significant LDL-C reduction (from median 112 mg/dL [IQR 116-130] to median 31 mg/dL [IQR 1.6-2.5]) was observed, and the efficacy lasted for a 1-year treatment period. No significant changes were noted in the creatinine levels of the patients or trough concentrations of the calcineurin inhibitor drugs. Moreover, new-onset episodes of rejections or diabetes mellitus were not observed in any patient, and no patients developed additional cardiovascular events during the observation period.

【Conclusion】 The present study showed that PCSK9 inhibitors significantly lowered LDL-C levels in kidney transplant patients, and no adverse effects that interfered with the management of the transplanted kidneys were observed.