Like many cardiac patients, Randy Poitra struggled with high cholesterol. His LDL, or bad cholesterol, was through the roof. While the optimal LDL level is less than 100 mg/dL, Poitra’s was in the 500s.
His doctor, Trinity Health cardiologist Emad Dodin, MD, and nurse practitioner, Amanda Weidler, FNP-C, counseled him on dietary changes. He also prescribed a statin, a class of drugs (think Crestor or Lipitor) that have long been best practice therapy for managing elevated cholesterol.
“We tried statins. I think they work well for most people, but I developed kidney trouble,” Poitra said.
Poitra was among a small percentage of patients for whom statins either don’t work or produce unwelcome side effects.
“Statins are very effective for most patients, but 10 to 15 percent can’t tolerate them because of adverse side effects, most commonly muscle pain,” Dr. Dodin explained. “Another three to four percent don’t respond because of genetic conditions. We’ve needed an alternative for these people.”
Dr. Dodin knew of one. He quickly recognized that Poitra might be a candidate for a new generation of cholesterol-lowering medications called PCSK9 inhibitors. Approved by the FDA in 2015, this new class of drugs lowers LDL or “bad cholesterol” using a different approach than statins.
Whereas statins work by blocking a substance the body needs to make cholesterol. PCSK9 inhibitors lower cholesterol by targeting a protein (PCSK9) that binds itself to LDL cholesterol and prevents the liver from clearing it away, thus causing LDL to build up in the bloodstream. PCSK9 inhibitors produce antibodies that inactivate the PCSK9 protein and allowing the liver to perform its normal LDL-clearing function.
“We were part of the Odyssey trial that put these medicines to the test,” Dr. Dodin said. “The data from these patient trials are ready to be published. It’s going to be exciting once the data is out. More than 30 of my patients are on these medications, and the results have been very promising.”
According to Dr. Dodin, preliminary research shows that PCSK9 inhibitors, used as an add-on therapy to statins, can produce very good results. “Taking the maximum dose of Crestor can lower baseline cholesterol by 60 percent,” Dr. Dodin noted. “A PCSK9 inhibitor can lower it an additional 50 to 60 percent on top of that.”
Some clinical trials have even reported reduced death, heart attack, and stroke rates among patients taking the PCSK9 inhibitor compared to a placebo group.
The two PCSK9 inhibitors currently approved by the FDA are sold as Praluent and Repatha. They’re taken via injection once or twice a month, which hasn’t been an issue for Poitra. “It’s very simple,” he said. “The medication comes in pen form. You press it onto your shoulder, squeeze the top of the pen, and let it go.”
The downside is the cost. While statin drugs are fairly cheap, PCSK9 inhibitors are quite pricey, costing over $14,000 a year. Dr. Dodin and other cardiologists are hopeful the price will eventually come down, but time will tell.
“My nurses are very helpful when it comes to the paperwork and working with the patient’s insurance company. But even with insurance coverage the co-pays can run as high as $100 a month, and a lot of patients aren’t able to manage that,” Dr. Dodin added.
But patients like Poitra who have no other option aren’t necessarily thinking about the cost.
“Twenty-two weeks ago, my cholesterol was very elevated. Now my bad cholesterol is down to 75 to 150, and I haven’t experienced any side effects,” Poitra said. “It’s changed my life quite a lot. I have a lot more energy and feel a lot better. I think Dr. Dodin saved my life.”
For more information about Trinity’s Cardiology Services, contact Emad Dodin, MD, Valentine Chikwendu, MD, or Samir Turk, MD, at 857-7388. Their offices are located at Health Center – Medical Arts, 400 Burdick Expressway East, in Minot.