Registry study shows large reduction of clinical outcomes by lipoprotein apheresis

The German Lipoprotein Apheresis Registry (GLAR) – more than seven years on

Presented at the virtual EAS 2021 by Volker Schettler (Göttingen, Germany)

Introduction and methods

Data from the German Apheresis Registry from 2012-2020 were presented. 83 Apheresis centers participated and more than 2000 patients who underwent lipoprotein apheresis (LA) were enrolled, resulting in 47.685 documented LA treatments. Definition of major coronary events (MACE) was new ACS (STEMI or NSTEMI), new instable angina pectoris or new intervention. In addition, outcome of major non-coronary events (MANCE) was evaluated, including new cerebrovascular disease or diseases that affect the peripheral system.

Main results

• The majority of patients at the start of LA was between 50-59 (33%) and 60-69 years (32.5%). ~2/3 Of patients were male. During the study period with LA treatments, the number of patients 70 and older increased (34.1%).
• Of a total of 1050 patients, 353 Patients underwent 6-10 years of treatment and 180 patients >10 years of treatment.
• Majority of patients had either hypercholesterolemia (438 patients {of whom 166 had heterozygous FH] or elevated Lp(a) (746 patients).
• History of coronary heart disease (n=1478) was most common in this group of patients.
• Robust reduction of LDL-c were observed with LA throughout the years (ranging 68.1-69.6%).
• Reduction in Lp(a) was >70% during the years of LA treatments.
• MACE was reduced by 79% after 2 years of LA treatment and MANCE was reduced by 61% after the start of LA. Lowering of MACE and MANCE was stable throughout the study duration.
• Frequency of adverse events by LA treatments was between 1.97% and 3.757% in 2017-2020. Most common adverse event was puncture problems

Conclusion

An analysis of the GLAR registry showed an impressive decrease of MACE and MANCE within two years of initiation of LA, which was stable throughout the duration of the study. Number of side effects are low and LA is safe. Schettler said at the end that with the arrival of new lipid-lowering therapy (PCSK9 inhibitors or PCSK9 siRNA) number of LA treatment may reduce over the following years, however, this is unsure due to increased attention to severe lipoprotein disorders.

-Our reporting is based upon the information provided at the EAS 2021 congress-