Baseline characteristics and response to evinacumab in females and males with homozygous familial hypercholesterolemia in the ELIPSE OLE study.

Aim: Evinacumab is an ANGPTL-3 inhibitor developed for the treatment of homozygous familial hypercholesterolemia (HoFH), a rare condition characterized by extremely elevated LDL-cholesterol (LDL-C) levels and premature atherosclerotic cardiovascular disease. Despite important sex-related disparities in lipid metabolism, females are still underrepresented in trials, limiting the generalizability of results. With 116 patients, of which 49 % were females, the ELIPSE-OLE study has the largest cohort of HoFH females involved in a clinical trial. The aim of this analysis was to compare response to evinacumab in females and males in the ELIPSE OLE study. Methods: This study is a post hoc exploratory analysis of data on 57 females and 59 males, aged ≥12 years and on stable background lipid-lowering therapy (LLT) from ELIPSE OLE. Patients received evinacumab 15 mg/kg intravenously every 4 weeks. The primary efficacy endpoint was the reduction in LDL-C concentration from baseline to week-24. Results: Baseline LDL-C [mean (SD)] tended to be higher in females aged 18 to <50 than males: 8.4(5.4) vs 6.4(3.5) mmol/L. Following treatment with evinacumab, the percent decrease in LDL-C reached at week-24 was 44 % in the overall cohort and was sustained over time. Evinacumab significantly decreased LDL-C in both sexes, regardless of age and background LLT. There was a trend, although not significant, toward higher relative precent decrease of LDL-C among females. Conclusion: In a study where half of the participants were females, evinacumab led to substantial LDL-C reduction in HoFH patients of both sexes, regardless of genotype or background LLT.