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Seijas-Amigo J, Mauriz-Montero MJ, Suarez-Artime P, Gayoso-Rey M, Estany-Gestal A, Casas-Martínez A, González-Freire L, Rodriguez-Vazquez A, Pérez-Rodriguez N, Villaverde-Piñeiro L, Castro-Rubinos C, Espino-Faisán E, Rodríguez-Mañero M, Cordero A, González-Juanatey JR. Cognitive Function with PCSK9 Inhibitors: A 24-Month Follow-Up Observational Prospective Study in the Real World-MEMOGAL Study. Am J Cardiovasc Drugs 2023; 23:583-593. [PMID: 37612529 PMCID: PMC10462529 DOI: 10.1007/s40256-023-00604-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The cognitive safety of monoclonal antibody proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) has been established in clinical trials, but not yet in real-world observational studies. We assessed the cognitive function in patients initiating PCSK9i, and differences in cognitive function domains, to analyze subgroups by the low-density lipoprotein cholesterol (LDL-C) achieved, and differences between alirocumab and evolocumab. METHODS This has a multicenter, quasi-experimental design carried out in 12 Spanish hospitals from May 2020 to February 2023. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). RESULTS Among 158 patients followed for a median of 99 weeks, 52% were taking evolocumab and 48% alirocumab; the mean change from baseline in MoCA score at follow-up was + 0.28 [95% CI (- 0.17 to 0.73; p = 0.216)]. There were no significant differences in the secondary endpoints-the visuospatial/executive domain + 0.04 (p = 0.651), naming domain - 0.01 (p = 0.671), attention/memory domain + 0.01 (p = 0.945); language domain - 0.10 (p = 0.145), abstraction domain + 0.03 (p = 0.624), and orientation domain - 0.05 (p = 0.224)-but for delayed recall memory the mean change was statistically significant (improvement) + 0.44 (p = 0.001). Neither were there any differences in the three stratified subgroups according to lowest attained LDL-C level-0-54 mg/dL, 55-69 mg/dL and ≥ 70 mg/dL; p = 0.454-or between alirocumab and evolocumab arms. CONCLUSION We did not find effect of monoclonal antibody PCSK9i on neurocognitive function over 24 months of treatment, either in global MoCA score or different cognitive domains. An improvement in delayed recall memory was shown. The study showed no differences in the cognitive function between the prespecified subgroups, even among patients who achieved very low levels of LDL-C. There were no differences between alirocumab and evolocumab. REGISTRATION ClinicalTtrials.gov Identifier number NCT04319081.
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Affiliation(s)
- Jose Seijas-Amigo
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Travesía da Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
- Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Pedro Suarez-Artime
- Pharmacy Department, Complejo Hospitalario Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Gayoso-Rey
- Pharmacy Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - Lara González-Freire
- Pharmacy Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | | | | | | | - Moisés Rodríguez-Mañero
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Travesía da Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Division, Hospital IMED Elche, Alicante, Spain
- Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - José R. González-Juanatey
- Cardiology Department, Complejo Hospitalario Universidad de Santiago de Compostela, Travesía da Choupana s/n, 15706 Santiago de Compostela (A Coruña), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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