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Lomitapide in homozygous familial hypercholesterolemia

cardiology perspective from a single-center experience

Sperlongano, Simonaa; Gragnano, Felicea; Natale, Francescoa; D’Erasmo, Laurab; Concilio, Claudiaa; Cesaro, Arturoa; Golia, Enricaa; Crisci, Marioa; Sperlongano, Rossellaa; Fimiani, Fabioa; Russo, Mariagiovannaa; Arca, Marcellob; Limongelli, Giuseppea; Calabrò, Paoloa

Journal of Cardiovascular Medicine: March 2018 - Volume 19 - Issue 3 - p 83–90
doi: 10.2459/JCM.0000000000000620
Research articles: Cardiovascular prevention
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Aims Homozygous familial hypercholesterolemia (HoFH) is a genetic dyslipidemia characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C) and accelerated atherosclerosis. Frequently, traditional lipid-lowering therapy is ineffective in these patients, and lipoprotein apheresis is required. Lomitapide has been recently approved for HoFH. We reported our experience in HoFH patients treated with lomitapide, evaluating its efficacy and safety profile.

Methods Probands suspected for familial hypercholesterolemia were extrapolated from the registry of patients admitted to our cardiology department. Dutch Lipid Clinic Network (DLCN) criteria were adopted to diagnose familial hypercholesterolemia clinically. Individuals receiving a definite or probable diagnosis of familial hypercholesterolemia underwent family cascade screening and genetic test. Patients with a genetic diagnosis of HoFH were treated with lomitapide and monitored with serial follow-up visits.

Results Within 1 year of screening, from a population of 3250 patients admitted to our cardiology department, seven probands were selected with a DLCN score greater than 5. A total of two patients resulted genetically homozygotes for familial hypercholesterolemia and started lomitapide. A marked reduction in LDL-C occurred in both patients on lomitapide (78% reduction in patient 1 and 86% in patient 2 already on lipoprotein apheresis, compared with baseline LDL-C), allowing the apheresis treatment to be stopped in the second case. Lomitapide was well tolerated, and both patients experienced only mild gastrointestinal events.

Conclusion Lomitapide is an effective and well tolerated cholesterol-lowering drug approved for the treatment of HoFH patients. It would be useful to administer it early in these patients to reduce LDL-C and avoid the development of fatal cardiovascular complications.

aDivision of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania ‘Luigi Vanvitelli’, A.O. dei Colli Monaldi Hospital, Naples

bDepartment of Internal Medicine and Clinical Specialties, Policlinico Umberto 1, ‘Sapienza’ University of Rome, Rome

Correspondence to Professor Paolo Calabrò, MD, PhD, Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania ‘Luigi Vanvitelli’, A.O. dei Colli Monaldi Hospital, Naples, Italy Tel: +39 81 706 5289; fax: +39 81 706 4285; e-mail: paolo.calabro@unicampania.it

Received 3 August, 2017

Revised 2 December, 2017

Accepted 16 December, 2017

© 2018 Italian Federation of Cardiology. All rights reserved.