ESC Congress 2026 Abstract · Oct 26, 2026

Real-world outcomes of biweekly and monthly alirocumab regimens: a population-based analysis

By Tan GM, Lai A, Yan BP

Background: Alirocumab, a PCSK9 inhibitor, is widely used in Hong Kong for managing dyslipidaemia in high-risk patients. However, real-world data comparing different dosing intervals are limited. Understanding whether dosing frequency influences lipid outcomes, medication adherence, and cardiovascular events may inform clinical practice and healthcare planning. Purpose: This study aimed to evaluate the clinical and lipid outcomes of patients prescribed biweekly versus monthly alirocumab across Hong Kong, with a subgroup analysis focusing on patients with acute coronary syndrome (ACS). Methods: A retrospective territory-wide cohort study was conducted, including all adults prescribed alirocumab between June 1, 2020, and December 31, 2025. Patients were categorized according to dosing frequency (biweekly or monthly). The primary outcome was 12-month major adverse cardiovascular events (MACE), comprising myocardial infarction, stroke, coronary revascularization (PCI/CABG), or cardiovascular death. Secondary outcomes included compliance (defined as discontinuation of therapy) and achievement of LDL-cholesterol (LDL-C) goals: <1.4 mmol/L, <1.8 mmol/L, and >50% reduction from baseline. Subgroup analyses were performed for patients with ACS. Statistical comparisons were conducted using appropriate inferential tests. Results: A total of 2012 patients were included, with 72.0% receiving biweekly and 28.0% monthly dosing. At 12 months, there was no statistically significant difference in the incidence of MACE between groups (8.6% vs. 8.9%; p=0.829). Monthly dosing was associated with superior treatment persistence (83.7% vs. 77.2%; p=0.001) and higher proportions achieving LDL-C targets at all thresholds: <1.4 mmol/L (64.8% vs. 54.0%; p=<0.001), <1.8 mmol/L (75.5% vs. 66.2%; p=0.002), and >50% LDL reduction (56.6% vs. 48.0%; p=0.007). In the ACS subgroup (n=404), both regimens demonstrated comparable rates of MACE and lipid control (all p>0.05). Conclusions: In this real-world Hong Kong cohort, monthly alirocumab dosing led to better adherence and LDL target attainment but similar cardiovascular outcomes compared with biweekly dosing. Among ACS patients, efficacy was comparable. Monthly dosing appears to be a convenient and effective option for maintaining lipid control without compromising safety.

doi.org/10.1093/eurheartj/ehag785.4127 Open access Interventions