RNAi jab to reduce cholesterol available on NHS

A new anti-cholesterol injection has been accepted for use on the NHS, and may soon be available to patients in an effort to prevent heart attacks and strokes.

Cholesterol, a fatty substance made in the liver, exists in different forms which have important roles in the production of hormones, vitamin D and cell membranes. However, low density lipoproteins (LDL), sometimes referred to as 'bad' cholesterol, can build up in the lining of the arteries and increase the risk of cardiovascular disease. A new drug, Inclisiran, will be offered to patients who have had a previous cardiovascular event, such as a stroke, and who have persistently high levels of LDL cholesterol despite taking a statin or other cholesterol-lowering drugs. It is estimated that in doing so, Inclisiran could prevent up to 55,000 heart attacks and strokes within the next ten years.

'Inclisiran represents a potential game-changer in preventing thousands of people from dying prematurely from heart attacks and strokes,' said Meindert Boysen, the deputy chief executive for the National Institute for Health and Care Excellence (NICE).

Inclisiran is a modern class of medication which uses RNA interference or 'gene silencing' to prevent the production of certain chemicals. In the case of Inclisiran, the drug inhibits the translation of the PCSK9 gene which in turn reduces the patient's levels of LDL cholesterol in the blood. After an initial dose and subsequent dose given three months later, Inclisiran is given as a twice-yearly injection either alone or in conjunction with a statin or other cholesterol-lowering drug. This, along with the fact that the drug can be administered in the community by doctors, nurses and pharmacists, makes it a convenient therapy for patients.

Professor Kosh Ray, from the department of public health and primary care at Imperial College London, said: 'The challenge we have at the moment is that with pills, they require daily dosing, and over time people become less adherent, they forget to take the medication or don't get refills'.

While the drug will initially only be offered to patients with established cardiovascular disease, those with elevated levels of LDL alone may be offered Inclisiran in the future. 'NICE have said it will be made available to people whose cholesterol levels are above 2.6 millimoles and can't be reduced enough with statins alone,' said Professor Ray.

Professor Sir Nilesh Samani, medical director at the British Heart Foundation commented that 'more research is needed to confirm the full extent of its benefits, but I anticipate that in the future it will also be approved to lower cholesterol for a much wider group of people to prevent them from having a heart attack or stroke in the first place.'

The draft advice for providing Inclisiran has been published by NICE.