Starting from a rare adverse reaction: a warning of an elderly person’s allergic reaction to PCSK9 inhibitors

  

Recently, a heart-wrenching case has attracted widespread attention in the medical community.

A 70-year-old man had to be hospitalized urgently because of severe adverse reactions after taking the new lipid-lowering drug evolocumab. This case sounded the alarm for us: even innovative drugs that are currently recognized as safe may cause unexpected reactions in a very small number of patients.

Let’s take a look at this old man’s experience and how doctors solved this difficult problem.

Amir (pseudonym) is an elderly man of Lebanese and Syrian descent. Since he was in his 30s, he has been diagnosed with familial hypercholesterolemia (FH), a hereditary disease.

His low-density lipoprotein cholesterol (LDL-C) was as high as 400mg/dL, far exceeding the normal value. Senile rings appeared around his eyes, which is a typical sign of long-term high blood lipids. More worryingly, his coronary artery calcification score was as high as 3350.77, and his carotid artery also had mild to moderate atherosclerosis.

In order to control blood lipids, the doctor prescribed him conventional lipid-lowering drugs such as statins and ezetimibe. However, the effect was not ideal, and LDL-C still remained at around 130mg/dL.

Considering Amir’s condition, doctors decided to add a new lipid-lowering drug, evolocumab, which is a PCSK9 inhibitor that is given by injection once every two weeks.

Unexpectedly, within 24 hours of the first injection, Amir developed flu-like symptoms. Although the symptoms were relieved within 6 days after taking paracetamol, the situation took a turn for the worse after the second injection.

[One shot almost cost me my life]

24 hours after the second injection of eloumab, Amir began to experience nausea, vomiting, fever and other symptoms. His temperature once rose to 39.4℃ and he had to be hospitalized urgently.

Inspection found:

Submandibular lymphadenopathy, pericardial effusion , pleural effusion, multiple lymphadenopathy, abnormal liver function, and elevated multiple inflammatory indicators . The doctors immediately stopped all lipid-lowering drugs and gave him antibiotics, colchicine, and prednisone. After five days of hospitalization, Amir’s symptoms gradually improved.

[Medical experts solve the mystery]

Why did such a severe reaction occur? Doctors conducted a series of examinations and analyses:

Are you allergic to latex? Because the syringe needle cover of eloumab contains latex, but the skin prick test and patch test were negative. 2. Are you allergic to polysorbate?

Eloumab contains 0.06%-0.068% polysorbate but the related allergy test was also negative. 3. Have anti-drug antibodies been produced?

Eloumab is a fully human monoclonal antibody with a low likelihood of immunogenicity. In clinical trials, only 0.3% of patients produced non-neutralizing binding antibodies. Ultimately, experts believe that this is most likely an IgE-independent T cell-mediated cytokine α response.

【Turning point and enlightenment】

The story does not end here. Considering that Amir still needed to further lower his blood lipids, the doctors chose a new drug for him, inclisiran, which has a completely different mechanism of action.

Fortunately, after using Inclisiram for one month, Amir not only did not experience any adverse reactions, but his LDL-C also dropped to the ideal level of 67 mg/dL.

This case brings us important enlightenment:

Even widely recognized safe drugs may cause serious adverse reactions in individual patients . When facing adverse reactions, systematic thinking is needed: record the time of symptom occurrence in detail, comprehensively check various indicators, systematically investigate possible causes, and find alternative treatment options. 2. For patients who need to use PCSK9 inhibitors:

It is recommended to ask whether there is a history of latex allergy before first use. If necessary, relevant allergen testing can be carried out. Close observation for 24-72 hours after injection. If you feel unwell, seek medical attention in time. [Warm Tips]

If you are currently using or planning to use a PCSK9 inhibitor, please be aware of the following:

Use the medicine according to the doctor’s instructions and pay attention to the body’s reaction after taking the medicine. If the following symptoms occur, seek medical attention immediately: persistent fever, severe fatigue , difficulty breathing, chest pain, etc. 4. Perform regular follow-up examinations

In short, innovative drugs have brought us new treatment options, but we must also remain vigilant and not be overly afraid or take it lightly. Only by using drugs rationally under the guidance of doctors can the therapeutic value of drugs be truly brought into play.

Pa