PCSK9 Inhibitors and Statins -- some actual numbers

I was taking a 75 mg/mL dose of Praluent (alirocumab) in addition to a 2 mg dose of a statin (Livalo) when I had my blood work done in November 2015.  My doctor then discontinued the statin and raised the dose of Praluent to 150 mg/mL.  I had a blood draw in mid-February.  In comparing the results, the quick and dirty analysis is that my LDL went up slightly, but is still well under where it needs to be, my HDL went up moderately, my triglycerides went up moderately, and my liver enzymes were in the normal range for the first time since I started statins.

Bottom line:  I have yet to discuss with my doctor, but my instinct is to stay off of statins (reducing the risk of CPT2 episodes) and continue with the Praluent.

Here is a brief summary of my results:

	Aug. 2014	Dec. 2014	Nov. 2015	Feb. 2016
	No statin, no Praluent	Livalo 2 mg	Praluent 75 mg, Livalo 2 mg	Praluent 150 mg, no statin
LDL	198	140	77	91
HDL	40	47	42	53
VLDL	45	24	20	21
Triglycerides	305	150	144	182
AST	25	31	44	25
ALT	60	44	64	39
Creatine Kinase	173	164	192	118

Obviously, these tests are a snapshot in time.  It is also worth noting that between the November 2015 test and the February 2016 test, I relaxed my vigilance about consuming cholesterol, so I ate more foods with cholesterol.  However, it seems pretty clear that my liver (AST, ALT) and my CPT2 (Creatine Kinase) do much better without the statin (yes, I'm aware that a 192 CK is within the normal range, but it is worth noting that my "baseline" CK is lower in the Feb. 2016 than I ever remember seeing it in any test while on a statin).  My LDL went up by around 18% when dropping the statin and increasing the Praluent, and is still 35% lower than it was on the statin alone.  However, my HDL also went up -- by 26%, a good sign.

On the non-testable front, I feel better without taking the statin.  I've had fewer muscle incidents as well.  I haven't had any side effects from the Praluent except for slight bruising at the injection site the one time I injected it in the stomach area.  Although the instructions say you can do that, it really hurt and I won't be picking that area again.

PCSK9 Inhibitors and CPT2

I stopped taking a statin and switched to a PCSK9 inhibitor.  I'm taking 150 mg of Praluent.  My LDL dropped dramatically, to around half of what it was before.  Much more effective than the statin, and none of the muscle damage that was happening with the combination of a statin and CPT2.

However, Anthem Blue Cross is currently refusing to cover Praluent, and I can't afford to pay for it without insurance coverage.  If I go back to a statin, I'm likely to end up in the hospital again.  The last time, it was 6 days and probably cost the insurance company $100,000 or so.  So I'm at a loss as to why they don't want to cover it.  I'm still trying to make coverage happen.

Bottom line, though, is that if you can afford to switch to a PCSK9 inhibitor, you should definitely talk to your doctor about it.  My CPT2 symptoms have dramatically improved on the PCSK9 inhibitor, and I'm not looking forward to having to get off of it and back on a statin.  Hopefully the insurance company will do the right thing and I won't have to.