{"id":"0a3f0a435003","type":"article","url":"https://hartvaat.nl/2026/04/01/lp-a-verlaging-vergelijkbaar-tussen-alle-pcsk9-gerichte-middelen/","title":"Lp(a)-verlaging vergelijkbaar tussen alle PCSK9-gerichte middelen","title_en":"","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","enlicitide","lipidenverlaging","lipoproteïne-a","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","pelacarsen"],"journal":"Journal of clinical lipidology","doi":"10.1016/j.jacl.2026.03.019","source_url":"https://doi.org/10.1016/j.jacl.2026.03.019","authors":["Martin D Mulligan","Rahul S Gandhi","Rishabh Vishwakarma","Romit Bhattacharya"],"significance":7,"published":"2026-05-02","source_date":"2026-04-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"A systematic review and meta-analysis of 31 RCTs showed that PCSK9 inhibitors and inclisiran reduce lipoprotein(a) by a pooled 25.8% versus control (95% CI −29.5 to −22.0). Meta-regression found no significant differences between alirocumab, evolocumab and inclisiran; lerodalcibep and enlicitide produced similar ~25% reductions. For Lp(a) lowering the agent matters little — choice can be guided by dosing frequency, cost and patient preference. None of these drugs is approved purely for Lp(a) lowering yet.","created":"2026-07-03T10:32:50Z","updated":"2026-07-03T13:31:45Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse van 31 RCT's toonde dat PCSK9-remmers en inclisiran lipoproteïne(a) gemiddeld met 25,8% verlagen versus controle (95% BI -29,5 tot -22,0). Meta-regressie liet geen significante verschillen zien tussen alirocumab, evolocumab en inclisiran onderling, en lerodalcibep en enlicitide gaven vergelijkbare reducties van ongeveer 25%. Voor Lp(a)-verlaging maakt het middel weinig uit; de keuze kan dus primair gestuurd worden door doseerfrequentie, kosten en patiëntvoorkeur. Geen van deze middelen is officieel goedgekeurd voor Lp(a)-verlaging alleen.","abstract_original":"BACKGROUND AND AIMS: Lipoprotein(a) [Lp(a)] is a causal contributor to atherosclerotic cardiovascular disease (ASCVD). While no therapies are currently approved solely for lowering Lp(a), subgroup analyses suggest that individuals with elevated Lp(a) may gain added benefit from intensive lipid-lowering strategies. No prior meta-analysis has compared evolocumab, alirocumab, inclisiran, lerodalcibep, and enlicitide in their Lp(a)-lowering efficacy. We aimed to determine whether PCSK9-targeted therapies differ significantly in Lp(a) reduction, or whether agent selection can be guided primarily by other factors such as dosing frequency, cost, and patient preference. SOURCES OF MATERIAL: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) reporting percent change in Lp(a) following treatment with the five PCSK9-targeted agents. A random-effects model calculated pooled estimates of percentage Lp(a) change, and mixed-effects meta-regression assessed differences between agents. ABSTRACT OF FINDINGS: Thirty-one RCTs were included. PCSK9 inhibitors and inclisiran reduced Lp(a) by a pooled mean of -25.76% versus control (95% CI -29.54 to -21.99; P < .0001). Meta-regression revealed no significant differences between agents (alirocumab vs evolocumab: +3.3%, 95% CI -1.40 to 8.07, P = .16; inclisiran vs evolocumab: +4.9%, 95% CI -2.31 to 12.16, P = .18; inclisiran vs alirocumab: +1.6%, 95% CI -5.38 to 8.55, P = .65). Lerodalcibep and enlicitide demonstrated similar approximate 25% reductions; however, insufficient trial numbers precluded a powered head-to-head comparison. CONCLUSIONS: No statistically significant differences in Lp(a) reduction were observed between currently available PCSK9-targeting medications. Agent selection may reasonably be based on non-efficacy factors, including administration frequency, cost, and patient preference."}