Lipoprotein apheresis was associated with reduced concentrations of low-density lipoprotein-cholesterol (LDL-C) and lipoprotein (a) in patients with hyperlipoproteinemia (a) and familial hypercholesterolemia (FH) on a maximally tolerated lipid-lowering regimen, according to a study published in the Journal of Clinical Apheresis.
In this longitudinal study, the data of 23 Polish patients (ages, 37-77 years) with hyperlipoproteinemia (a) (43%) or FH (57%) who were treated with lipoprotein apheresis (n=1014 sessions; average 24.12±4.44 months) at a single site between 2013 and 2020 were examined. Patients were evaluated for cardiovascular events, and LDL-C and Lp(a) concentrations, pre- and post-apheresis.
During lipoprotein apheresis sessions, which occurred weekly or biweekly, 45 mL of plasma volume per kg (for the Membrane Filtration Optimized Novel Extracorporeal Treatment technique) or 1.5 L of blood volume (for the direct adsorption by polyacrylate/polyacrylamide technique) were processed with a median blood flow of 110 mL/min (interquartile range [IQR], 90.0-120.0 mL/min), and the use of heparin and acid citrate dextrose. Sessions lasted a median of 145.0 minutes (IQR, 125.0-173.0 minutes). Access for lipoprotein apheresis was through an arteriovenous fistula (n=13) or via the peripheral vein (n=9).
At baseline, median LDL-C was 155 mg/dL (IQR, 107-228 mg/dL) and Lp(a) was 0.56 g/L (IQR, 0.14-1.37 g/L). After lipoprotein apheresis, LDL-c concentrations were reduced by 70.0% (median, 50 mg/dL; IQR, 30-73.5 mg/dL) and Lp(a) concentrations by 72.7% (median, 0.13 g/L; IQR, 0.05-0.34 g/L). Apheresis treatment was also associated with reductions in concentrations of triglycerides (54.69%), total cholesterol (57.2%), and high-density lipoprotein cholesterol (20%).
Adverse cardiovascular events decreased from an annual median rate of 0.365 (IQR, 0.0-0.585) at baseline to 0.0 (IQR, 0.0-0.265; P =.047) post-apheresis, and major adverse cardiovascular events decreased from a median annual rate of 0.365 (IQR, 0.0-0.585) pre-apheresis to 0.0 (IQR, 0.0-0.265; P =.031) post-apheresis.
A total of 8.7% of patients experienced adverse events, and 5% of LA sessions were complicated by vascular access, and 2.9% by hypotension.
This study was limited by its sample size, however, only 25 patients were currently undergoing LA treatment in Poland, so this study was thought to be representative for the country.
“Long-term lipoprotein apheresis therapy should be used for individuals with hyper-Lp(a) and for patients with elevated Lp(a), FH and LDL-C above recommended targets despite maximally tolerated lipid-lowering drugs,” concluded the study authors.
Mickiewicz A, Marlega J, Kuchta A, et al. Cardiovascular events in patients with familial hypercholesterolemia and hyperlipoproteinaemia (a): Indications for lipoprotein apheresis in Poland. [published online January 2, 2021] J Clin Apher. doi:10.1002/jca.21872