Alirocumab

How it works

It binds PCSK9 and prevents it from degrading hepatic LDL receptors, so more receptors recycle to the cell surface and clear LDL cholesterol from the blood.

Prescribing in practice

• NICE restricts alirocumab to specific LDL-cholesterol thresholds and risk categories, so eligibility should be confirmed against current NICE criteria before initiation.
• It is given by subcutaneous injection on an intermittent schedule, typically as add-on to maximally tolerated statin and/or ezetimibe therapy.
• Injection-site reactions are the most common adverse effect; it can be continued in patients who are statin-intolerant.

Monitoring

Check LDL cholesterol after initiation to confirm an adequate lipid-lowering response and guide ongoing therapy.

Counselling the patient

• Teach the patient correct subcutaneous self-injection technique and to rotate injection sites.
• Explain that it is added to, and does not replace, dietary measures and other lipid-lowering treatment unless statins are not tolerated.
• Advise that mild injection-site redness or itching can occur and is usually transient.

Evidence & guidelines

The ODYSSEY OUTCOMES trial showed alirocumab reduced major adverse cardiovascular events after acute coronary syndrome, and NICE recommends it within defined eligibility criteria.