Cochrane · systematic review · CD011748
PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease
Schmidt, AF, Carter, J-PL, Pearce, LS, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
16
current version
GRADE rated
15
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 1 · 6.3%Very low 3 · 18.8%Low 4 · 25%Moderate 0 · 0%High 8 · 50%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyAlirocumab compared with placebo
Population: people at high risk of CVD (history of CVD or high LDL‐C despite treatment)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CVD Alirocumab vs placebo | OR 0.87 [0.8, 0.94] | 10 studies · 23868 participants | High |
All‐cause mortality Alirocumab vs placebo | OR 0.83 [0.72, 0.96] | 12 studies · 24797 participants | High |
Myocardial infarction Alirocumab vs placebo | OR 0.86 [0.79, 0.94] | 9 studies · 23352 participants | High |
Any stroke Alirocumab vs placebo | OR 0.73 [0.58, 0.91] | 8 studies · 22835 participants | High |
Evolocumab compared with placebo
Population: people at high risk of CVD (history of CVD or high LDL‐C despite treatment)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CVD Evolocumab vs placebo | OR 0.84 [0.78, 0.91] | 3 studies · 29432 participants | High |
All‐cause mortality Evolocumab vs placebo | OR 1.04 [0.91, 1.19] | 3 studies · 29432 participants | High |
Myocardial infarction Evolocumab vs placebo | OR 0.72 [0.64, 0.82] | 3 studies · 29432 participants | High |
Any stroke Evolocumab vs placebo | OR 0.79 [0.65, 0.94] | 2 studies · 28531 participants | High |
Alirocumab compared with ezetimibe and statins
Population: people at high risk of CVD (history of CVD or high LDL‐C despite treatment)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CVD Alirocumab vs ezetimibe and statins | OR 1.37 [0.65, 2.87] | 3 studies · 1379 participants | Low Downgraded: imprecision |
All‐cause mortality Alirocumab vs ezetimibe and statins | OR 0.51 [0.18, 1.4] | 5 studies · 1733 participants | Low Downgraded: imprecision |
Myocardial infarction Alirocumab vs ezetimibe and statins | OR 1.45 [0.64, 3.28] | 5 studies · 1734 participants | Low Downgraded: imprecision |
Any stroke Alirocumab vs ezetimibe and statins | OR 0.85 [0.13, 5.61] | 5 studies · 1734 participants | Low Downgraded: imprecision |
Evolocumab compared with ezetimibe and statins
Population: people at high risk of CVD (history of CVD or high LDL‐C despite treatment)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
CVD Evolocumab vs ezetimibe and statins | OR 0.66 [0.14, 3.04] | 1 study · 218 participants | Very low Downgraded: risk of bias, imprecision |
All‐cause mortality Evolocumab vs ezetimibe and statins | OR 0.43 [0.14, 1.3] | 3 studies · 5223 participants | Very low Downgraded: risk of bias, imprecision |
Myocardial infarction Evolocumab vs ezetimibe and statins | OR 0.66 [0.23, 1.85] | 3 studies · 5003 participants | Very low Downgraded: risk of bias, imprecision |
Any stroke Evolocumab vs ezetimibe and statins | no estimate extracted | 2 studies · 3899 participants | Ungraded |
Summary of findings for PCSK9 compared with placebo
Population: people at high risk of cardiovascular disease (history of CVD or high LDL‐C despite treatment)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
LDL‐C reduction (LDL‐C) Summary of findings for PCSK9 vs placebo | no estimate extracted | 8 studies · 4782 participants | Moderate Downgraded: risk of bias |
Cardiovascular disease (CVD) Summary of findings for PCSK9 vs placebo | OR 0.86 [0.8, 0.92] | 8 studies · 59294 participants | Moderate Downgraded: risk of bias, indirectness |
All‐cause mortality (mortality) Summary of findings for PCSK9 vs placebo | OR 1.02 [0.91, 1.14] | 12 studies · 60684 participants | Moderate Downgraded: risk of bias, indirectness |
Any adverse events (adverse events) Summary of findings for PCSK9 vs placebo | OR 1.08 [1.04, 1.12] | 13 studies · 61038 participants | Low Downgraded: risk of bias, indirectness |
CI: confidence interval Summary of findings for PCSK9 vs placebo | no estimate extracted | NR | No studies |
Summary of findings for PCSK9 compared with ezetimibe
Population: people at high risk of cardiovascular disease (history of CVD or high LDL‐C despite treatment)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
LDL‐C reduction (LDL‐C) Summary of findings for PCSK9 vs ezetimibe | no estimate extracted | 2 studies · 823 participants | Moderate Downgraded: risk of bias |
Cardiovascular disease (CVD) Summary of findings for PCSK9 vs ezetimibe | no estimate extracted | NR | No studies |
All‐cause mortality (mortality) Summary of findings for PCSK9 vs ezetimibe | no estimate extracted | NR | No studies |
Any adverse events (adverse events) Summary of findings for PCSK9 vs ezetimibe | no estimate extracted | NR | No studies |
CI: confidence interval Summary of findings for PCSK9 vs ezetimibe | no estimate extracted | NR | No studies |
Summary of findings for PCSK9 compared with ezetimibe and statins
Population: people at high risk of cardiovascular disease (history of CVD or high LDL‐C despite treatment)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
LDL‐C reduction (LDL‐C) Summary of findings for PCSK9 vs ezetimibe and statins | no estimate extracted | 5 studies · 5376 participants | Moderate Downgraded: risk of bias |
Cardiovascular disease (CVD) Summary of findings for PCSK9 vs ezetimibe and statins | OR 0.45 | 3 studies · 4770 participants | Very low Downgraded: risk of bias |
All‐cause mortality (mortality) Summary of findings for PCSK9 vs ezetimibe and statins | no estimate extracted | NR | No studies |
Any adverse events (adverse events) Summary of findings for PCSK9 vs ezetimibe and statins | OR 1.18 [1.05, 1.34] | 5 studies · 5376 participants | Low Downgraded: risk of bias |
CI: confidence interval Summary of findings for PCSK9 vs ezetimibe and statins | no estimate extracted | NR | No studies |