Efficacy and safety of different doses of evolocumab in reducing low-density lipoprotein cholesterol levels: A meta-analysis

Evolocumab has been considered as an efficacious, safe and promising therapeutic modality for hypercholesterolemia and is associated with cardiovascular diseases. The efficacy and safety of two different doses of evolocumab were evaluated and the safety of evolocumab was compared with that of a placebo and ezetimibe. PubMed and EMBASE databases were searched and randomized controlled trials that examined the effect and safety of evolomucab compared with a placebo and ezetimibe were retrieved. Two authors independently performed article reviews and study quality evaluations. Odds ratios (ORs) were calculated using a fixed or random-effects model [95% confidence intervals (CIs)]. In the direct comparison, a significant reduction was observed in the muscle-associated events compared with ezetimibe [OR=0.54 (95% CI, 0.31–0.93); P (Z)=0.03, P (Q)=0.43, I(2)=0%]. In the adjusted indirect comparison of evolocumab 140 mg Q2W vs. evolocumab 420 mg Q4W, no significant differences in efficacy [OR=1.04 (95% CI, 0.55–1.99); P (Z)=0.90] or adverse events [OR=1.08 (95% CI, 0.66–1.74); P (Z)=0.76] were identified. The funnel plots of these direct comparison studies indicated that there was no publication bias. The results of this meta-analysis demonstrate that evolocumab significantly reduced low-density lipoprotein cholesterol levels, and no difference was noted between evolocumab 140 mg Q2W and evolocumab 420 mg Q4W. Furthermore, evolocumab had fewer muscle-associated events than ezetimibe.