ESC Congress 2016 - 25

Your FREE access to ESC Congress content all year long www.escardio.org/365 ESC CONGRESS 2016 IN REVIEW 7 6 5 4 Alirocumab 150 mg Q2W (n = 41) 5.0/191.6 4.5/174.7 4.3/166.0 Placebo (n = 21) 4.5/172.6 4.3/165.0 250 4.5/175.2 150 4.5/175.1 3 100 2 2.4/92.1 2.5/98.1 2.4/93.6 8-10 10-12 12-14 2.5/95.2 2.4/94.3 1 0 200 0 14-16 16-18 mg/dL Average LDL-C Value, Mean, mmol/L Figure 2. Time-Averaged LDL-C Concentrations (Kroon Formula)1 50 0 Interval (weeks) LDL-C % Change From Baseline (%), LS Mean (SE) Alirocumab Placebo Week 6 -53.7 (2.3) 1.6 (3.1) P value vs placebo < .0001 Week 18 -42.5 (4.7) 3.9 (6.3) < .0001 Data labels are expressed in both mmol/L and mg/dL measurements. Kroon AA et al. Atherosclerosis. 2000;152:519-526. LS, least squares; SE, standard error. 1 Adapted from Moriarty PM et al. Alirocumab in patients with heterozygous familial hypercholesterolaemia undergoing lipoprotein apheresis: the ODYSSEY ESCAPE trial. Eur Heart J. 2016; doi:10.1093/eurheartj/ehw388. By permission of Oxford University Press on behalf of the European Society of Cardiology. The alirocumab group had a 75% additional reduction in the rate of standardized lipoprotein apheresis compared with the placebo group from Week 7 to 18 (Hodges-Lehmann median estimate of treatment difference: 0.75; 95% CI, 0.67 to 0.83; P < .0001; Figure 1). During this time, 63.4% of alirocumab-treated patients had no apheresis treatments and 92.7% had a ≥ 50% reduction in apheresis frequency. Patients treated with alirocumab vs placebo had significant reductions in LDL-C from baseline to Week 6 (-53.7% vs +1.6%; P < .0001) and Week 18 (-42.5% vs +3.9%; P < .0001; Figure 2). Alirocumab significantly reduced apolipoprotein B and non-high-density lipoprotein cholesterol (nonHDL-C) levels versus placebo (P < .0001). No significant difference in lipoprotein(a) reduction was observed for alirocumab versus the placebo group. Treatment-emergent adverse event rates were similar in the alirocumab (75.6%) and placebo (76.2%) groups. The ODYSSEY ESCAPE trial demonstrated that alirocumab significantly reduced the frequency of lipoprotein apheresis in patients with HeFH who were not achieving recommended LDL-C levels prior to this treatment. Treatment with alirocumab 150 mg every 2 weeks may allow patients with HeFH to terminate or reduce the frequency of lipoprotein apheresis. Since apheresis is costly (approximately $2500 per session in the US), timeconsuming (4 hours), and available only in selected cities, the use of a PCSK9 inhibitor to reduce the need for apheresis in patients with HeFH represents an important step forward in the treatment of these very high risk patients. CMR-Guided Management Strategy Reduces Rate of Unnecessary Angiography in CE-MARC 2 Study Written by Phil Vinall John P. Greenwood, MB, ChB, PhD, Leeds General Infirmary, Leeds, United Kingdom, reported that management of patients with suspected coronary heart disease (CHD) using cardiovascular magnetic resonance (CMR) or myocardial perfusion scintigraphy-singlephoton emission computed tomography (MPS-SPECT) resulted in fewer unnecessary invasive coronary angiographies compared with patients managed with National Institute for Health and Care Excellence (NICE) 2010 guidelines. Previous studies have shown a weak correlation between abnormal non invasive testing and the likelihood of obstructive coronary artery disease at elective coronary angiography [Patel MR et al. Am Heart J. 2014; Patel MR et al. N Engl J Med. 2010]; yet pre test likelihood (PTL) models for CHD can overstate risk, paradoxically increasing the probability of invasive coronary angiography [Fox KA, McLean S. Heart. 2010]. This study tested the hypothesis that CMR-guided care is superior to NICE- and MPS-guided care in reducing the occurrence of unnecessary invasive angiography in patients with CHD. This was a randomized, parallel-group study [NCT01664858] in patients aged ≥ 30 years with suspected angina, who were suitable Official Peer-Reviewed Highlights From ESC Congress 2016 25 http://www.escardio.org/365

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