Inclisiran

How it works

It uses RNA interference to silence hepatic PCSK9 messenger RNA, reducing PCSK9 protein production so more LDL receptors are recycled to the hepatocyte surface, increasing clearance of circulating LDL-cholesterol.

Prescribing in practice

• After the first dose and a dose at three months, maintenance injections are given only twice yearly, so administration must be by a healthcare professional and recorded carefully to avoid missed long-interval doses.
• It is an adjunct to maximally tolerated statin therapy rather than a replacement; do not stop background lipid-lowering treatment when starting it.
• Injection-site reactions are the most common adverse effect and are usually mild and transient.

Monitoring

Check a lipid profile before starting and periodically thereafter to confirm response, though LDL response is not required to guide the fixed twice-yearly dosing schedule.

Counselling the patient

• This is a twice-a-year injection given by your clinic; keep your scheduled appointments as the effect wears off over months if doses are delayed.
• Continue your statin or other cholesterol tablets unless your doctor tells you to stop.
• Some redness or soreness at the injection site is common and settles quickly.

Evidence & guidelines

NICE recommends inclisiran as an option for adults with persistent high LDL-cholesterol despite maximally tolerated lipid-lowering therapy, supported by the ORION programme of randomised trials.