Evinacumab: Angiopoietin-like protein 3 (ANGPTL3) inhibitor

Angiopoietin-like protein 3 (ANGPTL3) is a protein synthesised by liver cells. It inhibits the expression lipoprotein lipase (LPL) gene. That will increase circulating triglycerides. Genetic activation of LPL gene can reduce triglycerides and is associated with low incidence of coronary artery disease and type 2 diabetes mellitus. Heterozygous loss of function mutations of ANGPTL3 are associated with reductions of both LDL cholesterol and triglycerides. Evinacumab is a monoclonal antibody against ANGPTL3, which can reduce triglycerides and has been approved for the reduction of LDL cholesterol in homozygous familial and other forms of hypercholesterolemia. Evinacumab is indicated when LDL cholesterol remains elevated in spite of traditional interventions. It has to be administered as an intravenous infusion, over 60 minutes, once every 4 weeks. As there is a potential for embryotoxicity, patients should be on contraceptive measures while on treatment and for 5 months after the last dose. ELIPSE HoFH phase 3 trial documented the efficacy of Evinacumab in patients with homozygous familial hypercholesterolemia receiving maximum doses of lipid-lowering therapy.