Individualized dosing of evinacumab is predicted to yield reductions in drug expenses

• Published in: Journal of clinical lipidology 2023-05, Vol.17 (3), p.401-405
• Main Authors: ter Heine, Rob, Rongen, Gerard A., Roeters van Lennep, Jeanine, Rutten, Joost H.W.
• Format: Article
• Language: English
• Subjects: Angiopoietin-Like Protein 3; Antibodies, Monoclonal; Cholesterol; Cholesterol, LDL; Cost reduction; Dose individualization; Dose reduction; Evinacumab; Familial hypercholesterolemia; Homozygous Familial Hypercholesterolemia; Humans; Pharmacodynamics; Pharmacokinetics
• ISSN: 1933-2874; 1876-4789
• DOI: 10.1016/j.jacl.2023.03.004

•Dose optimization of evinacumab may be used to reduce drug expenses.•An average 34% dose reduction might be possible without compromising efficacy.•This strategy may facilitate access to treatment of evinacumab by reducing costs. Evinacumab is a first-in-class inhibitor of angiopoietin‐like protein 3 (ANGPTL3) for treatment of the rare disease homozygous familial hypercholesterolemia (HoFH). With projected drug costs of $450,000 per person per year, the question rises if cost-efficacy of evinacumab can be further improved. To develop an individualized dosing regimen te reduce drug expenses. Using the clinical and pharmacological data as provided by the license holder, we developed an alternative dosing regimen in silico based on the principles of reduction of wastage by dosing based on weight bands rather than a linear milligram per kilogram body weight (mg/kg) dosing regimen, as well as dose individualization guided by low density lipoprotein cholesterol (LDL-C) response. We found that the average quantity of drug used for a dose could be reduced by 34% without predicted loss in efficacy (LDL-C reduction 24 weeks after treatment initiation). Dose reductions without compromising efficacy seem feasible. We call for implementation and prospective evaluation of this strategy to reduce treatment costs of HoFH.