Position of lipoprotein apheresis in present

Česká verzia

Authors: Vladimír Bláha ¹; Milan Bláha ²; Miriam Lánská ²; Eduard Havel ¹; Pavel Vyroubal ¹; Zdeněk Zadák ¹; Michal Vrablík ³; Jan Piťha ⁴; Pavel Žák ²; Luboš Sobotka ¹
Authors place of work: III. interní gerontometabolická klinika LF UK a FN Hradec Králové, přednosta prof. MUDr. Luboš Sobotka, CSc. ¹; IV. interní hematologická klinika LF UK a FN Hradec Králové, přednosta doc. MUDr. Pavel Žák, CSc. ²; Centrum preventivní kardiologie III. interní kliniky 1. LF UK a VFN Praha, přednosta prof. MUDr. Štěpán Svačina, DrSc., MBA ³; Institut klinické a experimentální medicíny Praha, ředitel MUDr. Aleš Herman, Ph. D. ⁴
Published in the journal: Vnitř Lék 2015; 61(11): 958-964
Category: Reviews

Summary

Lipoprotein apheresis (LA) is an effective treatment method the patients with severe hypercholesterolemia, resistant to the standard therapy. LA is an extracorporeal elimination technique, which specifically removes low density lipoprotein (LDL) cholesterol from the circulation. At present, lipoprotein apheresis, combined with high-dose statin and ezetimibe therapy, is the best available means of treating patients with homozygous and statin refractory heterozygous familial hypercholesterolaemia (FH). However, the extent of cholesterol-lowering achieved is often insufficient to meet the targets set by current guidelines. The recent advent of new classes of lipid-lowering agents provides new hope that the latter objective may now be achievable. These compounds act either by reducing low density lipoprotein (LDL) cholesterol production by inhibiting apolipoprotein B synthesis with an antisense oligonucleotide (mipomersen), or by inhibiting microsomal triglyceride transfer protein (lomitapid), or by enhancing LDL catabolism via monoclonal antibody-mediated inhibition of the activity of proprotein convertase subtilisin/kexin 9 (PCSK9 – alirocumab, evolocumab etc). The promising is the combination of LDL-apheresis with new drugs, namely for its potential to further decrease of LDL-cholesterol between apheresis. Depending on the outcome of current trials, it seems likely that these compounds, used alone or combined with lipoprotein apheresis, will markedly improve the management of refractory FH.

Key words:
alirocumab – atherosclerosis – cardiovascular disease – evolocumab – hypercholesterolemia –lipoprotein apheresis – lomitapid – mipomersen

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