On July 24 the FDA approved alirocumab, a new add-on drug to lower low-density lipoprotein (LDL) cholesterol in certain people. This monoclonal antibody injection drug works to inhibit protein convertase subtilisin/kexin type 9 (PCSK9). PCSK9 binds to the low-density lipoprotein receptors (LDLR) on the surface of hepatocytes to promote their degradation within the liver. LDLR is the primary receptor that clears circulating LDL cholesterol, therefore, the decrease in LDLR levels by PCSK9 results in higher blood levels of LDL-C. By inhibiting the binding of PCSK9 to LDLR, alirocumab increases the number of LDLRs available to clear LDL, thereby lowering LDL cholesterol levels. Initial dose is 75 mg by subcutaneous injection every two weeks. This dose may be increased to the maximum of 150 mg by subcutaneous injection every two weeks if a patient’s plasma LDL cholesterol concentration needs more reduction. The most common side effects are nasopharyngitis, influenza, and injection site itching, swelling, pain and/or bruising. What are your thoughts and concerns about this new drug?
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