{
  "abstract": "Introduction Inclisiran is an RNA interfering drug which binds to the mRNA of the precursor for proprotein convertase subtilisin-kexin type 9 (PCSK9). Recent trials 1–3 have showed that Inclisiran resulted in a reduction of LDL-cholesterol (LDL-C) by about 47%, sustained over 4 years in addition to maximum tolerated statins or other lipid lowering therapy. This study aims to utilize real world data to assess the efficacy of Inclisiran on high-risk patients post myocardial infarction and those intolerant to statins.Method Inclisiran was prescribed according to National Institute of Clinical Excellence guidance 2 if the LDL-C is persistently above 2.6 mmol/l and on maximum tolerated statins with or without other lipid lowering therapy or on other lipid lowering therapies where statins are not tolerated or contraindicated. This is an observational prospective study which the data were collected from the hospital’s electronic system. The total cholesterol (TC) and LDL-C levels were measured prior to first injection and at day 90. Patients without an extended lipid profile at day 90 were omitted from the data analysis.The cutoffs of 1.4 and 1.8 mmol/l and criteria for very high and high cardiovascular disease risks were based on ESC guidance.3 Results A total number of 75 patients were included for total cholesterol and 51 patients for LDL-C. The mean total cholesterol percentage reduction at day 90 was 28% ±3 (95% CI) with an absolute reduction of 1.7 mmol/l ±0.3 (95% CI) while the mean LDL-C percentage reduction at day 90 was 45% ±6 (95% CI) with an absolute reduction of 1.5 mmol/l ±0.2 (95% CI). In subgroup patients of those on statins and intolerant to statins, a mean TC percentage reduction of 30% ±6 (95% CI) and LDL-C percentage reduction of 52% ±12 (95% CI) was found in those with statins and Inclisiran. For those intolerant of statins, use of Inclisiran led to a mean TC reduction of 27% ±4 (95% CI) and LDL-C percentage reduction of 43% ±6 (95% CI).Of the 45 patients identified and grouped into acute myocardial infarction (AMI) (<3 months), recent myocardial infarction (RMI) (within 3 to 12 months) and cardiovascular disease risks (CVD) (MI >12 months or other CVD risks). 2 were AMI, 9 were RMI and 34 were CVD. The AMI group showed an absolute LDL-C reduction of 66% ±40 (95% CI), RMI an absolute LDL-C reduction of 50% ±11 (95% CI) and CVD an absolute LDL-C reduction of 44% ±7 (95% CI).The numbers of patients with LDL-C below 1.4 and 1.8 mmol/l prior to Inclisiran were only 2% (1/51) for both. On Day 90, 45% (23/51) of patients achieved an LDL-C level below 1.8 mmol/l and 27% (14/51) below 1.4 mmol/l.Conclusion At 90 days, use of Inclisiran led to a significant reduction in total cholesterol and LDL-C in patients at very high and high risk. In those with recent myocardial infarction and intolerance to statins, there appear to be a significant drop of 66% compared to 45% in stable CVD patients . Our study indicated that a significant proportion did not reach a target of 1.4 or 1.8mmol/l on singular Inclisiran use.Abstract 7-016 Table 1Abstract 7-016 Figure 1Abstract 7-016 Figure 2References Ray KK, Troquay RPT, Visseren FLJ, Leiter LA, Scott Wright R, et al. Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial. Lancet Diabetes Endocrinol. 2023 Feb;11(2):109–119.National Institute of Clinical Excellence Inclisiran for treating primary hypercholesterolaemia or mixed dyslipidaemia, Technology appraisal guidance, Reference number: TA733, published: 06 October 2021.Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: the task force for the management of dyslipidaemias of the European society of cardiology (ESC) and European atherosclerosis society (EAS). Eur Heart J. 2020,41:111–188. doi: 10.1093/eurheartj/ehz455.",
  "authors": [
    {
      "affiliations": [
        "Cardiology Unit, Department of Medicine, Manor Hospital, Walsall, WS2 9PS, UK"
      ],
      "name": "Yi Lung Gan"
    },
    {
      "affiliations": [
        "Cardiology Unit, Department of Medicine, Manor Hospital, Walsall, WS2 9PS, UK"
      ],
      "name": "Anura Kalansooriya"
    },
    {
      "affiliations": [
        "Cardiology Unit, Department of Medicine, Manor Hospital, Walsall, WS2 9PS, UK"
      ],
      "name": "Hannah Tranter"
    },
    {
      "affiliations": [
        "Medical School of King`s, Guy`s and St Thomas`, Strand, London WC2R 2LS UK"
      ],
      "name": "Hana Jaumdally"
    },
    {
      "affiliations": [
        "Cardiology Unit, Department of Medicine, Manor Hospital, Walsall, WS2 9PS, UK"
      ],
      "name": "Andrew Hartland"
    },
    {
      "affiliations": [
        "Cardiology Unit, Department of Medicine, Manor Hospital, Walsall, WS2 9PS, UK"
      ],
      "name": "Rumi Jaumdally"
    }
  ],
  "title": "7-016 Efficacy of Inclisiran in patients post myocardial infarction with high total cholesterol and LDL levels and intolerance to statins",
  "uid": "10cfdde1-c3eb-5c89-8dab-232cf96b5af2"
}