Transient injection site reaction to alirocumab during immune system activation: a case series.

Bär, Sarah; Räber, Irene; Koskinas, Konstantinos C; Schlapbach, Christoph; Räber, Lorenz (2022). Transient injection site reaction to alirocumab during immune system activation: a case series. European heart journal - case reports, 6(5), ytac187. Oxford University Press 10.1093/ehjcr/ytac187

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Background

Injection site reactions (ISRs) are known side effects of the proprotein convertase subtilisin kexin 9 (PCSK9) inhibitor alirocumab. Transient ISR to alirocumab after a long phase of good tolerability have not been reported previously.

Case summary

A 55-year-old woman (Patient 1) and a 77-year-old man (Patient 2) were treated with alirocumab for the management of dyslipidaemia. Both patients tolerated the treatment without side effects for 7 and 2 months, respectively. After an upper respiratory tract infection in Patient 1 and a first COVID-19 vaccination in Patient 2, both patients suddenly developed ISR with erythema, calor, and itching upon 2 (Patient 1) and 1 (Patient 2) subsequent injection(s), respectively. Symptoms resolved with local steroids, oral antihistamines, and cooling. After termination of the presumed immune system activated state, alirocumab was well tolerated again in both patients without recurrence of any ISR upon repeated applications.

Discussion

These are the first cases to report transient ISR to a PCSK9 inhibitor, possibly triggered by activation of the immune system, after prolonged good tolerability. Based on the transient and benign nature of the reaction, such patients should be encouraged to continue supervised treatment, as tolerability may return after resolution of the pro-inflammatory state.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Dermatology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Bär, Sarah, Koskinas, Konstantinos, Schlapbach, Christoph, Räber, Lorenz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2514-2119

Publisher:

Oxford University Press

Language:

English

Submitter:

Pubmed Import

Date Deposited:

23 May 2022 09:45

Last Modified:

05 Dec 2022 16:20

Publisher DOI:

10.1093/ehjcr/ytac187

PubMed ID:

35592747

Uncontrolled Keywords:

Alirocumab Case report Inflammation Injection site reaction PCSK9 inhibitor

BORIS DOI:

10.48350/170155

URI:

https://boris.unibe.ch/id/eprint/170155

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