Clinical guidance on the contemporary use of proprotein convertase subtilisin/kexin type 9 monoclonal antibodies

Diabetes Obes Metab. 2019 Apr:21 Suppl 1:52-62. doi: 10.1111/dom.13637.


There is now significant evidence for the benefits of lowering low-density lipoprotein cholesterol (LDL-c) to reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Although statins are the most widely prescribed lipid-lowering therapy that effectively lower LDL-c, especially in combination with ezetimibe, some patients require adjunctive therapy to further lower LDL-c and mitigate attendant risk of ASCVD. The gap can be filled by proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies whose use is currently supported by two recent cardiovascular outcome studies and new treatment guidelines. We provide an overview of extant studies investigating PCSK9 monoclonal antibodies in various patient populations, an update of the guidelines regarding their use and a case-based discussion.

Keywords: cardiovascular disease; lipid-lowering therapy; type 2 diabetes.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Atherosclerosis / etiology
  • Atherosclerosis / prevention & control*
  • Cholesterol, LDL / drug effects
  • Humans
  • Hypolipidemic Agents / therapeutic use*
  • PCSK9 Inhibitors*
  • Practice Guidelines as Topic


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Cholesterol, LDL
  • Hypolipidemic Agents
  • PCSK9 Inhibitors
  • PCSK9 protein, human