20.500.12556/DiRROS-29153 Real-world effectiveness and cardiovascular outcomes of PCSK9 inhibitor therapy a prospective registry study Background and Aims: Randomized trials showed efficacious lipid-lowering with PCSK9 inhibitors (PCSK9i), but real-world treatment is often limited by statin-associated side effects (SASE). We quantified the effectiveness, safety and cardiovascular outcomes of alirocumab, evolocumab and inclisiran in a national prospective registry. Methods: This was a prospective registry-based study of patients initiating a PCSK9i. Lipid trajectories were assessed at 0, 3, 9, 21, and 33 months. The average treatment effect of PCSK9i on lipid trajectories and cardiovascular outcomes was estimated by inverse probability of treatment weighting (IPTW) using covariate balancing propensity scores. Results: 1,385 patients (median age 64 years; 52% women; median baseline low-density lipoprotein cholesterol [LDL-C] 4 mmol/L, 57% SASE) were included and followed for 2459 patient-years. In patients on alirocumab (N=598), evolocumab (N=693), or inclisiran (N=94), mean unadjusted LDL-C reductions were –58.2% (–1.98 mmol/L), –58.9% (–2.09 mmol/L), and –33.2% (–1.17 mmol/L), respectively (p<0.001). IPTW-adjusted LDL-C reductions remained numerically greater for monoclonal antibodies but were no longer significantly different long-term. Predictors of greater LDL-C reduction were longer treatment duration, male sex, higher age, statin co-therapy and first-line use (p<0.001). Adverse events occurred in 31% of patients. Major adverse cardiovascular events were infrequent (2.6 per 100 personyears) with no significant between-drug differences after IPTW. Conclusions: PCSK9i are safe in real-world practice. Alirocumab and evolocumab achieve trial-like LDL-C reductions, while inclisiran shows attenuated effectiveness without statins. Meaningful residual risk persists despite therapy. PCSK9 inhibitors monoclonal antibodies siRNA real-world study inclisiran evolocumab alirocumab LDL-C statin intolerance cardiovascular outcomes zaviralci PCSK9 monoklonska protitelesa siRNA študije iz resničnega sveta zdravilo inclisiran zdravilo evolokumab zdravilo alirokumab LDL-C intoleranca na statine kardiovaskularni učinki true false true Angleški jezik Slovenski jezik Neznano 2026-04-22 11:58:39 2026-04-22 11:58:39 2026-04-23 04:02:13 0000-00-00 00:00:00 2026 0 0 Nasl. z nasl. zaslona; Opis vira z dne 18. 3. 2026; str. 1-13 [article no.] 106 Vol. 25 2026 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 616.1 1476-511X 10.1186/s12944-026-02897-3 272081411 RAZ_Kafol_Jan_2026.pdf RAZ_Kafol_Jan_2026.pdf 1 55736200B69165D14CF84478211D234E 56a065fde4942101acd202e159bc201f644d1c4a44c6026e89a36931270f294d f54208b1-3e31-11f1-a343-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=43569 https://link.springer.com/article/10.1186/s12944-026-02897-3 1 d90f5af1-3e31-11f1-a343-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=43568 Univerzitetni klinični center Ljubljana 0 0 0