- 期刊
高血脂治療的新時代：PCSK9抑制劑
A New Era of Treatment for Hyperlipidemia: PCSK9 Inhibitor
摘要
多年來statin類藥物一直是高血脂的標準療法，但在臨床上有許多病人即使在積極治療下仍無法達到理想的血脂濃度，或是對statin藥物耐受不佳，以致心血管相關風險居高不下。新的治療藥物PCSK9（proprotein convertase subtilisin/kexin type 9）抑制劑alirocumab及evolocumab的問世，標誌著高血脂治療新時代的來臨，傳統藥物難以治療的高風險病人在接受PCSK9抑制劑治療後，有相當高比例達到低密度脂蛋白膽固醇（low-density lipoprotein-cholesterol［LDL-C］）的治療目標，心血管相關風險隨之大幅降低，尤其是在患有家族性高膽固醇血症的病人。隨著藥物的進步，眼前面臨不同於以往的挑戰，PCSK9抑制劑長期用藥安全性、LDL-C濃度過低是否會造成健康問題、最佳的LDL-C治療目標為何，皆有待更多研究和使用經驗的累積來提供解答。
並列摘要
Statins have long been the standard treatment for hyperlipidemia. However, risks of cardiovascular (CV) events remain high for those who are unable to reach the low-density lipoprotein-cholesterol (LDL-C) target despite maximally tolerated lipid-lowering therapy, as well as those with statin intolerance. The advent of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, namely alirocumab and evolocumab, marked a new era of lipid-lowering therapy. It has been shown that after receiving PCSK9 inhibitor, a large proportion of high-risk patients who are refractory to conventional therapy, especially those with familial hypercholesterolemia (FH), can achieve LDL-C treatment goal with further reduction in CV risks. Questions have been raised regarding the long-term safety of PCSK9 inhibitor, health issues associated with very low LDL-C level, and the optimal LDL-C target. More studies and clinical experiences are needed to provide answers to these questions.