Alirocumab in Omani Patients with Familial Hypercholesterolemia Undergoing Lipoprotein Apheresis

Objective: To describe the effect of alirocumab in Omani patients with FH undergoing lipoprotein apheresis. Methods: We studied the efficacy of biweekly 150 mg alirocumab injection in LDL-C lowering in 2 patients with homozygous FH and 2 with compound heterozygous FH undergoing regular LDL apheresis. Results: The 4 patients were on 40 mg rosuvastatin, 10 mg ezetimibe and biweekly LDL apheresis The average plasma LDL-C before LDL apheresis has been around 6.0 mmol/L. Regular LDL-C apheresis was associated with an average 67% reduction in LDL-C (to ~1.98 mmol/L). This returns to around 6.0 mmol/L just before the regular LDL-C apheresis. However, since the introduction of regular alirocumab injections, the baseline is now around 2.9 mmol/L and not around 6.0 mmol/L (a 48% reduction of baseline LDL-C) The combination of LDL-C apheresis and alirocumab has been associated with a 74% reduction in LDL-C (to 0.74 mmol/L) The LDL apheresis frequency was reduced to once monthly in three patients but remained at biweekly frequency in one patient. Conclusions: The addition of alirocumab injection in homozygous and compound heterozygous FH patients on regular LDL-apheresis resulted in significant LDL-C reduction and reduction of the LDL apheresis frequency in these patients.