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Effect of a Monoclonal Antibody to PCSK9 on LDL Cholesterol
Open accessAbstract
BACKGROUND: Proprotein convertase subtilisin/kexin 9 (PCSK9), one of the serine proteases, binds to low-density lipoprotein (LDL) receptors, leading to their accelerated degradation and to increased LDL cholesterol levels. We report three phase 1 studies of a monoclonal antibody to PCSK9 designated as REGN727/SAR236553 (REGN727). METHODS: In healthy volunteers, we performed two randomized, single ascending-dose studies of REGN727 administered either intravenously (40 subjects) or subcutaneously (32 subjects), as compared with placebo. These studies were followed by a randomized, placebo-controlled, multiple-dose trial in adults with heterozygous familial hypercholesterolemia who were receiving atorvastatin (21 subjects) and those with nonfamilial hypercholesterolemia who were receiving treatment with atorvastatin (30 subjects) (baseline LDL cholesterol, >100 mg per deciliter [2.6 mmol per liter]) or a modified diet alone (10 subjects) (baseline LDL cholesterol, >130 mg per deciliter [3.4 mmol per liter]). REGN727 doses of 50, 100, or 150 mg were administered subcutaneously on days 1, 29, and 43. The primary outcome for all studies was the occurrence of adverse events. The principal secondary outcome was the effect of REGN727 on the lipid profile. RESULTS: Among subjects receiving REGN727, there were no discontinuations because of adverse events. REGN727 significantly lowered LDL cholesterol levels in all the studies. In the multiple-dose study, REGN727 doses of 50, 100, and 150 mg reduced measured LDL cholesterol levels in the combined atorvastatin-treated populations to 77.5 mg per deciliter (2.00 mmol per liter), 61.3 mg per deciliter (1.59 mmol per liter), and 53.8 mg per deciliter (1.39 mmol per liter), for a difference in the change from baseline of -39.2, -53.7, and -61.0 percentage points, respectively, as compared with placebo (P<0.001 for all comparisons). CONCLUSIONS: In three phase 1 trials, a monoclonal antibody to PCSK9 significantly reduced LDL cholesterol levels in healthy volunteers and in subjects with familial or nonfamilial hypercholesterolemia. (Funded by Regeneron Pharmaceuticals and Sanofi; ClinicalTrials.gov numbers, NCT01026597, NCT01074372, and NCT01161082.).
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“These findings have led to the development of monoclonal antibodies to PCSK9 that produce substantial reductions in LDL cholesterol when administered alone or with a statin. 8-12”
From Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome (2018) · cites this paper as [8]
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Sequence Variations in PCSK9, Low LDL, and Protection against Coronary Heart Disease
Cohen, J. C., Boerwinkle, E., Mosley, T. H., & Hobbs, H. H. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa054013 · Cited by 3,181
Mutations in PCSK9 cause autosomal dominant hypercholesterolemia
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Secreted PCSK9 decreases the number of LDL receptors in hepatocytes and inlivers of parabiotic mice
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A Spectrum of PCSK9 Alleles Contributes to Plasma Levels of Low-Density Lipoprotein Cholesterol
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- Olsson AG, 2001, Clin Cardiol, 24, III
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Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome
Schwartz, G. G., Steg, P. G., Szarek, M., Bhatt, D. L., Bittner, V. A., Diaz, R., Edelberg, J. M., Goodman, S. G., Hanotin, C., Harrington, R. A., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1801174 · Cited by 3,634
Large-scale association analysis identifies new risk loci for coronary artery disease
The CARDIoGRAMplusC4D Consortium, Deloukas, P., DIAGRAM Consortium, CARDIOGENICS Consortium, MuTHER Consortium, Wellcome Trust Case Control Consortium, Kanoni, S., Willenborg, C., Farrall, M., Assimes, T. L., et al. (2013) · Nature Genetics · doi:10.1038/ng.2480 · Cited by 1,614
Mechanisms of Acute Coronary Syndromes and Their Implications for Therapy
Libby, P. (2013) · New England Journal of Medicine · doi:10.1056/nejmra1216063 · Cited by 1,262
A Century of Cholesterol and Coronaries: From Plaques to Genes to Statins
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Loss-of-Function Mutations in APOC3, Triglycerides, and Coronary Disease
The TG and HDL Working Group of the Exome Sequencing Project, N. H. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1307095 · Cited by 1,071
Metadata
- Authors
- Stein, E. A., Mellis, S., Yancopoulos, G. D., Stahl, N., Logan, D., Smith, W. B., Lisbon, E., Gutierrez, M., Webb, C., Wu, R., Du, Y., Kranz, T., Gasparino, E., & Swergold, G. D.
- Affiliations
- Regeneron (United States) (US)
- Medpace (United States) (US)
- University of Tennessee Medical Center (US)
- IQVIA (United States) (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-03-22
- Volume
- 366
- Issue
- 12
- Pages
- 1108-1118
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1989730880
- Semantic Scholar
- 04c1ea8c55c4bae0da3106e47141bac81e1bb585
- Cited by
- 664
- References
- 15
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 29 · 2023: 22 · 2022: 19 · 2021: 20 · 2020: 38 · 2019: 29 · 2018: 46 · 2017: 58 · 2016: 62 · 2015: 86 · 2014: 83 · 2013: 92 · 2012: 57
- FWCI
- 103.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Regeneron Pharmaceuticals
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- PCSK9, monoclonal antibodies, LDL cholesterol, LDL receptor degradation, hypercholesterolemia, familial hypercholesterolemia, atorvastatin, lipid profile, adverse events, dose escalation, cholesterol absorption inhibition
- MeSH terms
- Atorvastatin, Proprotein Convertase 9, Adult, Antibodies, Monoclonal, Anticholesteremic Agents, Dose-Response Relationship, Drug, Drug Therapy, Combination, Female, Heptanoic Acids, Humans, Hypercholesterolemia, Hyperlipoproteinemia Type II, Injections, Intravenous, Injections, Subcutaneous, Lipoproteins, Cholesterol, LDL, Male, Middle Aged, Pyrroles, Receptors, LDL, Serine Endopeptidases, Least-Squares Analysis, Proprotein Convertases, Antibodies, Monoclonal, Humanized
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