Efficacy of evolocumab confirmed in large meta-analysis

Evolocumab demonstrates favourable effects on lipid profiles with an overall acceptable safety profile in adults with cardiovascular disease or major risk factors, according to a meta-analysis.

Dr Musa Khalil (Howard University Hospital, Washington DC, USA) presented results from a systematic review and meta-analysis of randomised clinical trials and cohort studies evaluating evolocumab in adults with cardiovascular disease or major risk factors [1]. The pooled data were analysed for efficacy (effects on lipids and major cardiovascular adverse events) and safety (therapy discontinuation and injection-site reactions). In total, 10 studies comprising 67,727 patients were included.

In the overall meta-analysis, evolocumab versus control resulted in a significant reduction in low-density lipoprotein cholesterol (LDL-C), with a mean difference of -57.7 mg/dL (95% CI, -60.7 to -54.8; P<0.0001). Additionally, evolocumab reduced in total cholesterol (mean difference -52.3 mg/dL; 95% CI -66. to -37.9; P<0.0001) and triglycerides (mean difference -21.2 mg/dL; 95% CI -26.0 to -16.4; P<0.0001), increased high-density lipoprotein cholesterol (HDL-C) (mean difference 3.7 mg/dL; 95% CI 1.7–5.7; P=0.0003), and significantly reduced major adverse cardiovascular events (RR 0.53; 95% CI 0.40–0.71; P<0.0001). These results were consistent in the subgroup of patients aged >60 years.

In terms of safety, there was a non-significant trend toward increased treatment discontinuation with evolocumab in both the overall population and the subgroup aged >60 years. There was also a trend toward increased injection-site reactions, which reached statistical significance in the older age group (RR 1.32; 95% CI 1.13–1.55; P=0.0004).

“Evolocumab significantly improves lipid profiles and reduces major adverse cardiovascular events in patients with or at high risk of cardiovascular disease, while demonstrating a generally favourable safety profile,” concluded Dr Khalil. “These results support evolocumab as an effective adjunct to standard lipid-lowering therapies, particularly in patients who are unable to tolerate statins or achieve LDL targets.”

Goel A, et al. Evolocumab decreases low density lipoprotein and reduces major adverse cardiovascular events – A systematic review and meta-analysis. ACC 2026, 28–30 March, New Orleans, LA, USA.