Long-term lipoprotein apheresis safely reduced LDL-C by an average of 69.4% in severe HeFH patients, with DALI and MONET systems showing similar LDL-C efficacy but DALI achieving greater Lp(a) reduction (80.0% vs 73.0%, p<0.001).
Observational (n=7)
No
Does long-term lipoprotein apheresis reduce LDL-C and Lp(a) safely in females with severe heterozygous familial hypercholesterolemia refractory to high-intensity statin therapy?
Long-term lipoprotein apheresis is safe and highly effective at reducing LDL-C and Lp(a) in patients with severe heterozygous familial hypercholesterolemia who are refractory to maximal lipid-lowering medical therapy.
Absolute Event Rate: 72.6% vs 74.1%
p-value: p=0.809
BACKGROUND: Severe familial hypercholesterolemia (FH) individuals, refractory to conventional lipidlowering medications are at exceptionally high risk of cardiovascular events. The established therapeutic option of last choice is lipoprotein apheresis (LA). Herein, it was sought to investigate the clinical usefulness of LA in a highly selected group of severe heterozygous FH (HeFH), as recently described by the International Atherosclerosis Society (IAS), for their efficacy in lipid reduction and safety. METHODS: Efficacy and safety of LA were investigated in 318 sessions of 7 severe HeFH females with cardiovascular disease, over a mean period of 26.9 ± 6.5 months. Relative reduction of low density lipoprotein cholesterol (LDL-C) ≥ 60%, clinical complications and vascular access problems were evaluated and compared between the direct adsorption of lipoproteins (DALI) and lipoprotein filtration (Membrane Filtration Optimized Novel Extracorporeal Treatment MONET). Additionally, lipoprotein (a) Lp(a), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), triglycerides (TG) and fibrinogen concentrations were investigated. RESULTS: The relative reduction of LDL-C, TC, TG and Lp(a) were 69.4 ± 12.9%, 59.7 ± 9.1, 51.5 ± ± 14.2% and 71.3 ± 14.4%, respectively. A similar efficacy was found in both systems in LDL-C removal. DALI system led to larger depletions of Lp(a) (80.0 76-83% vs. 73.0 64.7-78.8%; p < 0.001). The frequency of clinical side effects and vascular access problems were low (8.5%). CONCLUSIONS: Long-term LA in severe HeFH individuals is safe and efficiently reduces LDL-C and Lp(a). Higher efficacy of the DALI system than MONET in Lp(a) removal may indicate the need for individualized application of the LA system in severe HeFH individuals.
Mickiewicz et al. (Thu,) conducted a observational in Severe heterozygous familial hypercholesterolemia (HeFH) with cardiovascular disease (n=7). Lipoprotein apheresis (DALI vs MONET) vs. MONET system was evaluated on Relative reduction of LDL-C (p=0.809). Long-term lipoprotein apheresis safely reduced LDL-C by an average of 69.4% in severe HeFH patients, with DALI and MONET systems showing similar LDL-C efficacy but DALI achieving greater Lp(a) reduction (80.0% vs 73.0%, p<0.001).