BACKGROUND Many studies have investigated the progression of nonalcoholic fatty liver disease(NAFLD)and its predisposing risk factors,but the conclusions from these studies have been conflicting.More challenging is th...BACKGROUND Many studies have investigated the progression of nonalcoholic fatty liver disease(NAFLD)and its predisposing risk factors,but the conclusions from these studies have been conflicting.More challenging is the fact that no effective treatment is currently available for NAFLD.AIM To determine the effects of proprotein convertase subtilisin/kexin type-9(PCSK9)inhibitors on fatty infiltration of the liver.METHODS This retrospective,chart review-based study was conducted on patients,18-yearold and above,who were currently on PCSK9 inhibitor drug therapy.Patients were excluded from the study according to missing pre-or post-treatment imaging or laboratory values,presence of cirrhosis or rhabdomyolysis,or development of acute liver injury during the PCSK9 inhibitor treatment period;the latter being due to false elevation of liver function markers,alanine aminotransferase(ALT)and aspartate aminotransferase(AST).Radiographic improvement was assessed by a single radiologist,who read both the pre-and post-treatment images to minimize reading bias.Fatty infiltration of the liver was also assessed by changes in ALT and AST,with pre-and post-treatment levels compared by paired t-test(alpha criterion:0.05).RESULTS Of the 29 patients included in the study,8 were male(27.6%)and 21 were female(72.4%).Essential hypertension was present in 25(86.2%)of the patients,diabetes mellitus in 18(62.1%)and obesity in 15(51.7%).In all,patients were on PCSK9 inhibitors for a mean duration of 23.69±11.18 mo until the most recent ALT and AST measures were obtained.Of the 11 patients who received the radiologic diagnosis of hepatic steatosis,8(72.73%)achieved complete radiologic resolution upon use of PCSK9 inhibitors(mean duration of 17.6 mo).On average,the ALT level(IU/L)decreased from 21.83±11.89 at pretreatment to 17.69±8.00 at posttreatment(2-tailed P=0.042)and AST level(IU/L)decreased from 22.48±9.00 pretreatment to 20.59±5.47 post-treatment(2-tailed P=0.201).CONCLUSION PCSK9 inhibitors can slow down or even completely resolve NAFLD.展开更多
目的:探究前蛋白转化酶枯草杆菌蛋白酶/溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)抑制剂药物经济性评价的方法。方法:检索从建库至2024年1月15日PubMed,Embase,Scopus,Cochrane Library和Web of science数据库中有...目的:探究前蛋白转化酶枯草杆菌蛋白酶/溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)抑制剂药物经济性评价的方法。方法:检索从建库至2024年1月15日PubMed,Embase,Scopus,Cochrane Library和Web of science数据库中有关PCSK9抑制剂经济学研究的文献,并使用2022年版综合卫生经济评价报告标准(Consolidated Health Economic Evaluation Reporting Standards,CHEERS)对纳入的文献进行评估。结果:30篇关于PCSK9抑制剂药物治疗心血管疾病的经济学评价研究中27篇采用了模型法进行经济学评价,主要使用马尔可夫模型,涵盖了多个研究时限和健康状态数量。23篇文献通过低密度脂蛋白胆固醇(low-density lipoproteins-cholesterol,LDL-C)水平降低进行外推来评估药效,23篇文献未考虑药物的不良反应。结论:现有文献主要通过马尔可夫模型对药物的经济性进行评价,在药物效果指标的选择、药物不良反应是否纳入分析等方面存在局限性。展开更多
基金Data for this research project was obtained from Health System of the University of Kansas Medical Center,Kansas City,KS 66160,United States.The authors are grateful to the Department of Clinical Informatics at the University of Kansas Medical Center for their help in accessing the patient medical record database.Data extraction was conducted by the HERON automated data extraction tool.
文摘BACKGROUND Many studies have investigated the progression of nonalcoholic fatty liver disease(NAFLD)and its predisposing risk factors,but the conclusions from these studies have been conflicting.More challenging is the fact that no effective treatment is currently available for NAFLD.AIM To determine the effects of proprotein convertase subtilisin/kexin type-9(PCSK9)inhibitors on fatty infiltration of the liver.METHODS This retrospective,chart review-based study was conducted on patients,18-yearold and above,who were currently on PCSK9 inhibitor drug therapy.Patients were excluded from the study according to missing pre-or post-treatment imaging or laboratory values,presence of cirrhosis or rhabdomyolysis,or development of acute liver injury during the PCSK9 inhibitor treatment period;the latter being due to false elevation of liver function markers,alanine aminotransferase(ALT)and aspartate aminotransferase(AST).Radiographic improvement was assessed by a single radiologist,who read both the pre-and post-treatment images to minimize reading bias.Fatty infiltration of the liver was also assessed by changes in ALT and AST,with pre-and post-treatment levels compared by paired t-test(alpha criterion:0.05).RESULTS Of the 29 patients included in the study,8 were male(27.6%)and 21 were female(72.4%).Essential hypertension was present in 25(86.2%)of the patients,diabetes mellitus in 18(62.1%)and obesity in 15(51.7%).In all,patients were on PCSK9 inhibitors for a mean duration of 23.69±11.18 mo until the most recent ALT and AST measures were obtained.Of the 11 patients who received the radiologic diagnosis of hepatic steatosis,8(72.73%)achieved complete radiologic resolution upon use of PCSK9 inhibitors(mean duration of 17.6 mo).On average,the ALT level(IU/L)decreased from 21.83±11.89 at pretreatment to 17.69±8.00 at posttreatment(2-tailed P=0.042)and AST level(IU/L)decreased from 22.48±9.00 pretreatment to 20.59±5.47 post-treatment(2-tailed P=0.201).CONCLUSION PCSK9 inhibitors can slow down or even completely resolve NAFLD.
文摘目的:探究前蛋白转化酶枯草杆菌蛋白酶/溶菌素9(proprotein convertase subtilisin/kexin type 9,PCSK9)抑制剂药物经济性评价的方法。方法:检索从建库至2024年1月15日PubMed,Embase,Scopus,Cochrane Library和Web of science数据库中有关PCSK9抑制剂经济学研究的文献,并使用2022年版综合卫生经济评价报告标准(Consolidated Health Economic Evaluation Reporting Standards,CHEERS)对纳入的文献进行评估。结果:30篇关于PCSK9抑制剂药物治疗心血管疾病的经济学评价研究中27篇采用了模型法进行经济学评价,主要使用马尔可夫模型,涵盖了多个研究时限和健康状态数量。23篇文献通过低密度脂蛋白胆固醇(low-density lipoproteins-cholesterol,LDL-C)水平降低进行外推来评估药效,23篇文献未考虑药物的不良反应。结论:现有文献主要通过马尔可夫模型对药物的经济性进行评价,在药物效果指标的选择、药物不良反应是否纳入分析等方面存在局限性。
