Many do not know that in 2015 completely new drugs appeared that lower cholesterol are much more effective than statins.
Talks about these drugs Cardiologist, Candidate of Medical Sciences, Advisor to the Director General of the International Medical Cluster Yaroslav Ashikhmin.
– These are drugs evolokumab and alirokumab. With their help, it is possible to achieve a good reduction in cholesterol in 70% of patients. This is a very high rate. Drugs are administered subcutaneously every 2 weeks. Serious studies have shown that they are safe enough. They have a completely new mechanism of action. These are the so-called targeted drugs: they are aimed at a specific target – a special enzyme that plays an important role in the exchange of cholesterol (it has a complex and long name, abbreviated as PCSK9). These are not synthetic drugs that are familiar to us, but monoclonal human antibodies, similar to those produced by our immune system. Binding to the PCSK9 enzyme, they block its action.
Discovery story
An interesting story is the discovery of drugs. Scientists have studied people whose cholesterol is very low. Even in old age, the level of LDL (this is the so-called bad cholesterol) in them is no more than 1.5 mmol / l, as in infants. Due to this, atherosclerosis does not develop and very rarely there are heart attacks and strokes associated with it.
When scanning the genome, they found a mutation in the gene, which is involved in the destruction of LDL receptors. They bind this bad cholesterol in the blood and put it into the liver for processing (see infographic). If there are many such receptors, cholesterol from the blood is actively removed and thereby the risk of atherosclerosis is reduced. If there are few receptors, on the contrary, it remains more in the blood and it contributes to the development of atherosclerotic plaques. The destruction of these receptors activates the already known enzyme PCSK9. In people with a identified mutation, it is very small and, therefore, the receptors are almost not destroyed and therefore cholesterol is low. Naturally, scientists were tempted to make a medicine that would create the same situation as with this mutation. They succeeded.
Financial toxicity
But in this story, not everything is so cloudless. Doctors even coined the new term “financial toxicity”: these drugs are very expensive. More recently, a month of treatment they cost 53 thousand rubles. Now the price has been reduced to 35 thousand, but it is still very expensive. Our state has proved to be social, and if such drugs are really necessary, most patients after passing special commissions manage to get them for free. Today they are prescribed for a very high risk of heart attacks or strokes if statins are ineffective or when they are contraindicated due to complications (liver damage, muscle pain, etc.). I advise such patients, especially if they already had heart attacks and strokes before, go to the district hospital and go through a commission to receive treatment with such drugs.
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Indications for treatment by them are much wider, this is enshrined in the latest European recommendations for lowering cholesterol. At such a cost, it is unlikely that the most prosperous and socially oriented state can provide for all who need it. This is a problem not only in Russia, but also in the European Union. There is hope that in a few years it will be resolved through import substitution. In Russia, there are companies that can arrange the production of such drugs. They will be cheaper, but still remain expensive. Therefore, it seems to me that the state could allocate funds for the construction of plants for the production of these and other modern biological products that are used in the treatment of serious diseases in order to keep their cost at a lower level. This is of great social importance.
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