Key result
Lipoprotein apheresis faces a contracting role as targeted pharmacotherapies emerge for extreme dyslipidemia phenotypes.
Why the study?
It is debated whether lipoprotein apheresis remains indispensable for selected high-risk patients or whether modern and emerging lipid-lowering pharmacological agents have rendered it obsolete.
Does lipoprotein apheresis remain necessary for patients with extreme lipid-driven cardiovascular risk compared to modern pharmacological therapies?
Does lipoprotein apheresis remain necessary for patients with extreme lipid-driven cardiovascular risk compared to modern pharmacological therapies?
Lipoprotein apheresis remains a bridging or ultima ratio therapy for rare, extreme lipid phenotypes, but its role is rapidly shrinking due to advances in potent, targeted lipid-lowering pharmacotherapies.
Supports reserving apheresis for null-mutation HoFH until novel agents are accessible; leaves open comparative trials versus PCSK9i, inclisiran, and evinacumab.
Lipoprotein apheresis (LA) has long been used as an ultima ratio therapy for patients with extreme lipid-driven cardiovascular risk. One perspective maintains that, despite major advances in lipid-lowering pharmacology and the emergence of gene-silencing therapies, LA remains indispensable for selected patients with homozygous familial hypercholesterolaemia, severe hypercholesterolaemia refractory to maximal therapy, and isolated lipoprotein(a) [Lp(a)]-mediated progressive cardiovascular disease. An opposing view argues that modern and emerging pharmacological agents-PCSK9 inhibitors, inclisiran, bempedoic acid, evinacumab, and targeted Lp(a)-lowering antisense and small interfering RNA agents-have already rendered LA obsolete in almost all patients, with its remaining niche closing rapidly as outcome data accumulate. This combined manuscript juxtaposes the two positions in a streamlined form and concludes with a balanced conclusion of the future role of LA.
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Schettler et al. (2026) conducted a review in Severe dyslipidemia (homozygous familial hypercholesterolemia, elevated Lp(a)). Lipoprotein apheresis vs. Modern pharmacological lipid-lowering therapy was evaluated. Lipoprotein apheresis retains a narrow role for extreme lipid phenotypes like null-mutation HoFH, but its use will likely contract as novel targeted pharmacological therapies become widely available.
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