Taking proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors was associated with lower rates of death and fewer instances of intubation among patients with severe cases of COVID-19, according to a new study in the Journal of the American College of Cardiology.[1]
Increase in COVID-19 survival rates with PCSK9 inhibitors
Sometimes used for cholesterol management, PCSK9 inhibitors are lipid-lowering agents that potentially lower vascular inflammation, in part by reducing the body’s levels of interleukin-6 protein (IL-6) to less than half of baseline rates.
The lower levels of inflammation appear to have a positive impact on survival rates as well as the need for intubation, with 53.3% of placebo patients needing to be intubated or dying within 30 days, compared with just 23.3% of patients taking PCSK9 inhibitors.
Overall mortality for the patients on PCSK9 inhibitors was 16.7%, compared to 33% for the patients given a placebo.
Greater impacts for patients with intense inflammation
For those COVID-19 patients with intense inflammation—as indicated by baseline IL-6 levels above the median—those who took the PCSK9 inhibitors saw an even greater decrease in mortality than the placebo group, the study found. For these high-inflammatory patients, mortality risk was 37.5 percentage points lower for the group taking inhibitors than for the placebo group.
Other potential benefits of PCSK9 inhibitors: Shorter interventions
In addition to decreased mortality and decreased need for intervention, the patients who took PCSK9 inhibitors also benefited from shorter intervention periods, including shorter average hospital stays (16 vs. 22 days), shorter average duration of oxygen therapy (13 vs. 20 days), and shorter intubation duration (10 vs. 19 days).
About the patient population and need for follow-up
A total of 60 patients across four facilities in Poland were included in the study, and all of the patients were vaccinated against COVID-19. There were no documented side effects reported in relation to the administration of PCSK9 inhibitor or the placebo.
“The findings in this double-blind, randomized, pilot trial conducted in patients with severe COVID-19 indicate that administration of a single 140-mg dose of PCSK9 inhibitor may reduce the incidence of the composite of death or need for intubation at 30 days, without raising safety concerns, compared with placebo,” wrote first author Eliano P. Navarese, MD, PhD, of Nicolaus Copernicus University in Poland and the University of Alberta in Canada.
While the authors emphasize that the study is only a pilot and was not designed to statistically test any hypothesis of superior efficacy or safety, the initial findings offer an opportunity for follow-up with a larger trial to further explore the effects of PCSK9 and its resulting implications.