Claudia Stefanutti1, Ulrich Julius2, Gerald F Watts3, Mariko Harada-Shiba4, Maria Cossu5, Volker J Schettler6, Giustina De Silvestro7, Handrean Soran8, Jeanine Roeters Van Lennep9, Livia Pisciotta10, Hans U Klör11, Kurt Widhalm12, Patrick M Moriarty13. 1. Extracorporeal Therapeutic Techniques Unit, Lipid Clinic and Atherosclerosis Prevention Centre, Immunohematology and Transfusion Medicine, Department of Molecular Medicine, "Sapienza" University of Rome, "Umberto I" Hospital, Rome, Italy. Electronic address: claudia.stefanutti@uniroma1.it. 2. Department of Internal Medicine III, University Hospital Carl Gustav Carus at the TechnischeUniversität Dresden, Dresden, Germany. 3. Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia. 4. Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka, Japan. 5. Struttura Complessa Nefrologia Dialisi e Trapianto, Ospedale "SS. Annunziata", Azienda Ospedalier Universitaria, Sassari, Italy. 6. Center of Nephrology GoettingenGbR, Göttingen, Germany. 7. Serv. Immunoematologia e Trasfusionale Azienda Ospedaliera Università di Padova, Padova, Italy. 8. University Department of Acute Medicine, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, United Kingdom. 9. Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. 10. IRCCS AOU San Martino-IST, Department of Internal Medicine, University of Genoa, Genoa, Italy. 11. DGFF Lipid-Ligae.V, Frankfurt am Main, Hessen, Germany. 12. Academic Institute for Clinical Nutrition, Vienna, Austria. 13. Division of Clinical Pharmacology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Abstract
BACKGROUND: Despite advances in pharmacotherapy of lipid disorders, many dyslipidemic patients do not attain sufficient lipid lowering to mitigate risk of atherosclerotic cardiovascular disease. Several classes of novel lipid-lowering agents are being evaluated to reduce atherosclerotic cardiovascular disease risk. Lipoprotein apheresis (LA) is effective in acutely lowering the plasma concentrations of atherogenic lipoproteins including low-density lipoprotein cholesterol and lipoprotein(a), and novel lipid-lowering drugs may dampen the lipid rebound effect of LA, with the possibility that LA frequency may be decreased, in some cases even be discontinued. SOURCES OF MATERIAL: This document builds on current American Society for Apheresis guidelines and, for the first time, makes recommendations from summarized data of the emerging lipid-lowering drug classes (inhibitors of proprotein convertase subtilisin/kexin type 9 or microsomal triglyceride transfer protein, high-density lipoprotein mimetic), including the available evidence on combination therapy with LA with respect to the management of patients with dyslipidemia. ABSTRACT OF FINDINGS: Recommendations for different indications are given based on the latest evidence. However, except for lomitapide in homozygous familial hypercholesterolemia and alirocumab/evolocumab in heterozygous familial hypercholesterolemia subjects, limited data are available on the effectiveness and safety of combination therapy. More studies on combining LA with novel lipid-lowering drugs are needed. CONCLUSION: Novel lipid-lowering agents have potential to improve the performance of LA, but more evidence is needed. The Multidisciplinary International Group for Hemapheresis TherapY and Metabolic DIsturbances Contrast scientific society aims to establish an international registry of clinical experience on LA combination therapy to expand the evidence on this treatment in individuals at high cardiovascular disease risk.
BACKGROUND: Despite advances in pharmacotherapy of lipid disorders, many dyslipidemic patients do not attain sufficient lipid lowering to mitigate risk of atherosclerotic cardiovascular disease. Several classes of novel lipid-lowering agents are being evaluated to reduce atherosclerotic cardiovascular disease risk. Lipoprotein apheresis (LA) is effective in acutely lowering the plasma concentrations of atherogenic lipoproteins including low-density lipoprotein cholesterol and lipoprotein(a), and novel lipid-lowering drugs may dampen the lipid rebound effect of LA, with the possibility that LA frequency may be decreased, in some cases even be discontinued. SOURCES OF MATERIAL: This document builds on current American Society for Apheresis guidelines and, for the first time, makes recommendations from summarized data of the emerging lipid-lowering drug classes (inhibitors of proprotein convertase subtilisin/kexin type 9 or microsomal triglyceride transfer protein, high-density lipoprotein mimetic), including the available evidence on combination therapy with LA with respect to the management of patients with dyslipidemia. ABSTRACT OF FINDINGS: Recommendations for different indications are given based on the latest evidence. However, except for lomitapide in homozygous familial hypercholesterolemia and alirocumab/evolocumab in heterozygous familial hypercholesterolemia subjects, limited data are available on the effectiveness and safety of combination therapy. More studies on combining LA with novel lipid-lowering drugs are needed. CONCLUSION: Novel lipid-lowering agents have potential to improve the performance of LA, but more evidence is needed. The Multidisciplinary International Group for Hemapheresis TherapY and Metabolic DIsturbances Contrast scientific society aims to establish an international registry of clinical experience on LA combination therapy to expand the evidence on this treatment in individuals at high cardiovascular disease risk.
Authors: Gerald F Watts; Samuel S Gidding; Pedro Mata; Jing Pang; David R Sullivan; Shizuya Yamashita; Frederick J Raal; Raul D Santos; Kausik K Ray Journal: Nat Rev Cardiol Date: 2020-01-23 Impact factor: 32.419
Authors: Handrean Soran; Safwaan Adam; Jamal B Mohammad; Jan H Ho; Jonathan D Schofield; See Kwok; Tarza Siahmansur; Yifen Liu; Akheel A Syed; Shaishav S Dhage; Claudia Stefanutti; Rachelle Donn; Rayaz A Malik; Maciej Banach; Paul N Durrington Journal: Arch Med Sci Date: 2017-12-19 Impact factor: 3.318