Inclisiran

How it works

It is a small interfering RNA that, through the RNA interference pathway, reduces hepatic synthesis of PCSK9, allowing more LDL receptors to remain available to clear LDL-cholesterol from the blood.

Prescribing in practice

• It should be prescribed within the NICE technology appraisal eligibility criteria, generally as an adjunct to maximally tolerated statin therapy or where statins are contraindicated or not tolerated.
• It is administered by subcutaneous injection, initially and again after the first dose, then on a maintenance schedule given a few times a year by a healthcare professional.
• Injection-site reactions are the most commonly reported adverse effect.

Monitoring

Check the lipid profile to confirm an adequate LDL-cholesterol response, in keeping with the prescribing pathway.

Counselling the patient

• Explain that this is a long-acting injection given only a few times a year by a healthcare professional.
• Stress that it complements, and does not replace, statin therapy and a healthy diet.
• Report any persistent reaction at the injection site.

Evidence & guidelines

The ORION clinical trial programme demonstrated sustained LDL-cholesterol lowering with inclisiran, and NICE recommends it within defined eligibility criteria for cardiovascular risk reduction.