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Wg Cdr SS Iyengar, Bengaluru 18 October 2022

Lipoprotein apheresis is a very efficient but timeâ€‘consuming and expensive method of lowering levels of LDL-C, lipoprotein(a) [Lp(a)] and other apoB-containing lipoproteins, including triglyceride (TG)-rich lipoproteins.
Lipoprotein apheresis is typically carried out on a weekly or biweekly schedule. Some methods utilize plasma while others use whole blood.
Data from the German Lipoprotein Apheresis Registry, based on over 15,000 apheresis procedures, showed a median acute reduction in LDL-C of 69% and Lp(a) of 70% in hyperlipidemic patients with cardiovascular disease (CVD).
The UK Lipoprotein Apheresis Registry showed that the mean reduction in interval mean LDL-C from the pre-procedure baseline was 43.24% and 37.95% for Lp(a).
In the ODYSSEY ESCAPE trial, treatment of FH heterozygotes undergoing lipoprotein apheresis with the PCSK9 inhibitors alirocumab resulted in an additional 54% reduction in LDL-C.
With respect to elevated LDL-C, there is agreement that patients with homozygous FH inadequately responsive or refractory to lipid-lowering drugs qualify for such treatment.
Guidelines also agree that in homozygous FH, apheresis therapy should be started as early as possible, preferably in early childhood.

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