Painful and recurring injection site reaction to alirocumab and evolocumab in a young woman with familial hypercholesterolemia and effective therapeutic alternative based on inclisiran: a case report

Pregnancy 3 months after inclisiran injection: a unique case report including newborn baby monitoring

Background

Data on the safety of inclisiran, a lipid-lowering small interfering RNA (siRNA) inhibiting proprotein convertase subtilisin/kexin type 9 (PCSK9) secretion, during pregnancy are absent.

Case summary

A 30-year-old woman suffering from heterozygous familial hypercholesterolaemia started treatment with inclisiran 25 weeks before the start of gestation and received a second administration 13 weeks before the start of gestation. As soon as we became aware of the unplanned pregnancy, given the absence of any data regarding the administration of inclisiran during this period, the treatment was discontinued and the pregnancy was closely monitored. After a normal and full-term gestation, birth occurred at 41 + 0 gestational weeks. The baby was female and healthy, with normal anthropometry for her gestational age; her growth and development in the first 8 months of life followed a normal course.

Discussion

Potential harms to the foetus with systemic malformations have been highlighted with the genetically proxied LDL cholesterol lowering through PCSK9. To the best of our knowledge, this is the first case of pregnancy initiated few months after inclisiran administration, without reporting any adverse effect on the patient or the baby. More data are needed on the pharmacodynamics and safety of siRNAs in general, and of inclisiran in particular, to confirm that this drug could be safe even in this specific setting.

A Decadal Exploration of Cutaneous Adverse Effects of FDA-Approved Cardiovascular Medications: Insights From 2013 to 2023

ABSTRACT

Given the high prevalence of cardiovascular disease in the United States, there is a critical need for new medications to improve the outcomes of these diseases. The US Food and Drug Administration has approved numerous medications that are able to effectively do so. While these drugs have significantly beneficial effects, just like any other medication, they can come with a multitude of unwanted side effects. It has been noted that cardiovascular drugs have been associated with a considerable number of dermatologic reactions. This review examines current literature on the various cutaneous manifestations of these adverse reactions. It focuses on these newly Food and Drug Administration-approved cardiovascular medications from 2013 to 2023, detailing both common and rare effects in the past decade. As more medications continue to enter the market, the necessity for awareness of more systemic side effects will continue to grow. This comprehensive review aims to guide clinicians in identifying drug-induced reactions in patients on these therapies.

Molecular Therapies in Cardiovascular Diseases: Small Interfering RNA in Atherosclerosis, Heart Failure, and Hypertension

Small interfering RNA (siRNA) represents a novel, fascinating therapeutic strategy that allows for selective reduction in the production of a specific protein through RNA interference. In the cardiovascular (CV) field, several siRNAs have been developed in the last decade. Inclisiran has been shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) circulating levels with a reassuring safety profile, also in older patients, by hampering proprotein convertase subtilisin/kexin type 9 (PCSK9) production. Olpasiran, directed against apolipoprotein(a) mRNA, prevents the assembly of lipoprotein(a) [Lp(a)] particles, a lipoprotein linked to an increased risk of ischemic CV disease and heart valve damage. Patisiran, binding transthyretin (TTR) mRNA, has demonstrated an ability to improve heart failure and polyneuropathy in patients with TTR amyloidosis, even in older patients with wild-type form. Zilebesiran, designed to reduce angiotensinogen secretion, significantly decreases systolic and diastolic blood pressure (BP). Thanks to their effectiveness, safety, and tolerability profile, and with a very low number of administrations in a year, thus overcoming adherence issues, these novel drugs are the leaders of a new era in molecular therapies for CV diseases.