EC approves Praluent for CV risk in adults with CV disease

The European Commission (EC) has approved a new indication for Praluent (alirocumab), from Sanofi + Regeneron, to reduce cardiovascular (CV) risk in adults with established atherosclerotic CV disease (ASCVD) by lowering low-density lipoprotein cholesterol (LDL-C) levels as an adjunct to correction of other risk factors. The EC approval is based on data from ODYSSEY OUTCOMES, a Phase III CV outcomes trial that assessed the effect of adding Praluent to maximally-tolerated statins in 18,924 patients who had an ACS between 1-12 months (median 2.6 months) before enrolling in the trial. Results from the ODYSSEY OUTCOMES trial were published in The New England Journal of Medicine in 2018.

The trial met its primary endpoint, showing that Praluent significantly reduced the relative risk of major adverse CV events (MACE) by 15% in patients who had suffered a recent ACS. MACE occurred in 903 patients (9.5%) in the Praluent group and in 1,052 patients (11.1%) in the placebo group (HR 0.85; 95% CI, 0.78 to 0.93; p<0.001). Additionally, Praluent was associated with a 15% lower risk of death from any cause; which occurred in 334 (3.5%) patients in the Praluent group and 392 (4.1%) patients in the placebo group (HR 0.85; 95% CI, 0.73 to 0.98; nominal significance). Adverse events were similar between the Praluent and placebo groups, except for injection site reactions (Praluent 3.8%, placebo 2.1%).

Comment: Praluent is the only PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor available in two starting doses as a single 1 milliliter (mL) injection (75 mg and 150 mg) once every two weeks and can also be administered as 300 mg once every four weeks (monthly), enabling physicians to tailor treatment based on an individual patient's LDL-C-lowering needs. Data from ODYSSEY OUTCOMES have also been submitted to the FDA, with a target action date of April 28, 2019.