Anti PCSK9 Monoclonal Antibodies treatment in Elderly Patients – a Real-World Clinic Experience

Abstract Background: The use of anti PCSK9 monoclonal antibodies (mAb) is emerging. However, real-world data is lacking for elderly patients. Objective: To define the characteristics of elderly patients treated with anti PCSK9 mAb and to evaluate their efficacy and tolerability compared with younger subjects. Methods: A retrospective cohort study of elderly patients (≥75 years at enrolment) treated with anti PCSK9 mAb. Data was retrieved for demographic and clinical characteristics, indication for treatment, agents and dosages, concomitant lipid lowering treatment, LDL-c levels at baseline, 6, 12 months and at the end of follow up, reaching LDL-c target levels and adverse effects. Results: The cohort included 91 elderly patients and 92 younger ones, mean age 75.2 + 3.76 and 58.9 + 7.4 years (p<0.0001). Most patients (82%, 80%) were at the high/very high-risk categories, in almost all of them (98%, 99%) the indication was statin intolerance, with anti PCSK9 mAb monotherapy the most prevalent regimen. Most patients received Alirocumab (65%, 60%), 42% and 38% were treated by the 150 mg dose. The average follow up was 38.1 + 20.5 and 30.9 + 15.8 months (p=0.0258). Within 6 months the LDL-clevels were reduced by 57% in the elderly group and by 59% in the control group (p=0.2371) and were stable during follow up. Only 53% and 57% reached their LDL-c target levels. No clinically significant adverse events were documented. Conclusion: In the real - world setting, anti PCSK9 mAbs have similar effects and tolerability among elderly patients as in the younger population.