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A Bayesian network meta-analysis of PCSK9 inhibitors, statins and ezetimibe with or without statins for cardiovascular outcomes

dc.contributor.author Krasuski, Richard
dc.contributor.author Khan, Safi U
dc.contributor.author Talluri, Swapna
dc.contributor.author Riaz, Haris
dc.contributor.author Rahman, Hammad
dc.contributor.author Nasir, Fahad
dc.contributor.author Bin Riaz, Irbaz
dc.contributor.author Sattur, Sudhakar
dc.contributor.author Ahmed, Haitham
dc.contributor.author Kaluski, Edo
dc.date.accessioned 2019-02-01T14:47:55Z
dc.date.available 2019-02-01T14:47:55Z
dc.date.issued 2018-05-01
dc.identifier.issn 2047-4873
dc.identifier.issn 2047-4881
dc.identifier.uri https://hdl.handle.net/10161/17951
dc.description.abstract © 2018, © The European Society of Cardiology 2018. Background: The comparative effects of statins, ezetimibe with or without statins and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors remain unassessed. Design: Bayesian network meta-analysis was conducted to compare treatment groups. Methods: Thirty-nine randomized controlled trials were selected using MEDLINE, EMBASE, and CENTRAL (inception – September 2017). Results: In network meta-analysis of 189,116 patients, PCSK9 inhibitors were ranked as the best treatment for prevention of major adverse cardiovascular events (Surface Under Cumulative Ranking Curve (SUCRA), 85%), myocardial infarction (SUCRA, 84%) and stroke (SUCRA, 80%). PCSK9 inhibitors reduced the risk of major adverse cardiovascular events compared with ezetimibe + statin (odds ratio (OR): 0.72; 95% credible interval (CrI), 0.55–0.95; Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria: moderate), statin (OR: 0.78; 95% CrI: 0.62–0.97; GRADE: moderate) and placebo (OR: 0.63; 95% CrI: 0.49–0.79; GRADE: high). The PCSK9 inhibitors were consistently superior to groups for major adverse cardiovascular event reduction in secondary prevention trials (SUCRA, 95%). Statins had the highest probability of having lowest rates of all-cause mortality (SUCRA, 82%) and cardiovascular mortality (SUCRA, 84%). Compared with placebo, statins reduced the risk of all-cause mortality (OR: 0.88; 95% CrI: 0.83–0.94; GRADE: moderate) and cardiovascular mortality (OR: 0.84; 95% CrI: 0.77–0.90; GRADE: high). For cardiovascular mortality, PCSK9 inhibitors were ranked as the second best treatment (SUCRA, 78%) followed by ezetimibe + statin (SUCRA, 50%). Conclusion: PCSK9 inhibitors were ranked as the most effective treatment for reducing major adverse cardiovascular events, myocardial infarction and stroke, without having major safety concerns. Statins were ranked as the most effective therapy for reducing mortality.
dc.language en
dc.publisher SAGE Publications
dc.relation.ispartof European Journal of Preventive Cardiology
dc.relation.isversionof 10.1177/2047487318766612
dc.title A Bayesian network meta-analysis of PCSK9 inhibitors, statins and ezetimibe with or without statins for cardiovascular outcomes
dc.type Journal article
dc.date.updated 2019-02-01T14:47:54Z
pubs.begin-page 844
pubs.end-page 853
pubs.issue 8
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Medicine
pubs.organisational-group Clinical Science Departments
pubs.publication-status Published
pubs.volume 25
duke.contributor.orcid Krasuski, Richard|0000-0003-3150-5215


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