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Expert reaction to a study into cholesterol-lowering drugs

People who are unable to take statins due to muscle pains may benefit from a separate drug, evolocumab.

The drug has been shown to effectively lower cholesterol without causing pain, in new research published in the Journal of the American Medical Association (JAMA).

The study, led by scientists at the Cleveland Clinic, US, investigated the efficacy and side-effects of two non-statin therapies, evolocumab and ezetimibe. In the 24-week trial, patients who had previously reported muscle pain from statins were given one of the two non-statin drugs. The researchers then assessed participants' levels of harmful low-density lipoprotein (LDL) cholesterol.

Evolocumab, also called Repatha, was shown to effectively lower cholesterol levels, while the authors note that further studies are needed to assess the drug's long-term efficacy and safety.

Professor Liam Smeeth, Professor of Clinical Epidemiology at the London School of Hygiene & Tropical Medicine, commented on the findings:

"While this looks to be a robust study, I think some caution is needed in interpreting the meaning of these results for most patients. It is still far from clear whether statins really cause muscle symptoms in large numbers of patients, even though we know they can cause severe muscle problems in a very small proportion of patients. The new PCSK9 inhibitors do indeed seem effective in reducing cholesterol levels; however they've not been shown to protect people against cardiovascular disease, which is the only benefit of reducing cholesterol.

"In addition, PCSK9 inhibitors are hugely expensive. Given all of these factors, I don't think their use in clinical care outside of research studies would be justified."

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