Tafolecimab in Hyperlipidemia: A Study of Different Dosing Intervals

This is a prospective, observational cohort study conducted at the Department of Cardiology, Shandong First Medical University Affiliated First Hospital (Qianfoshan Hospital). The study aims to compare the efficacy and safety of Tafolecimab 150 mg administered every two weeks (Q2W) versus every three weeks (Q3W) in patients with hyperlipidemia who have not achieved their LDL-C targets after at least 4 weeks of moderate-intensity statin therapy, with or without cholesterol absorption inhibitors.

A total of 60 patients will be enrolled, with 30 patients allocated to each group based on clinical decision-making. Group A will receive Tafolecimab 150 mg subcutaneously every 2 weeks (Q2W), and Group B will receive Tafolecimab 150 mg subcutaneously every 3 weeks (Q3W). The treatment period is 12 weeks for both groups.

The primary efficacy outcome is the percent change in LDL-C from baseline at week 12. Secondary efficacy outcomes include the percent change in Lp(a) from baseline at week 12, LDL-C target achievement rates at each follow-up visit, and changes in TC, TG, HDL-C,, ApoB, and ApoA1 levels. Safety outcomes include the incidence of injection site reactions, liver transaminase elevation (ALT/AST ≥ 3×ULN), creatine kinase elevation (CK ≥ 5×ULN).

Follow-up visits are scheduled at week 2, 6, and 12 for Group A, and at week 3, 9, and 12 for Group B.

Inclusion criteria

• 1) Age ≥18 years. 2) Diagnosed with hyperlipidemia and on a stable, regular dose of moderate-intensity statins for at least 4 weeks (specifically: Atorvastatin 10 mg/d, Rosuvastatin 5 mg/d, Fluvastatin 80 mg/d, Pitavastatin 2-4 mg/d, Pravastatin 40 mg/d, Simvastatin 20-40 mg/d, or Xuezhikang 1.2 g/d), with or without concurrent cholesterol absorption inhibitors.

• Baseline LDL-C levels failing to reach the therapeutic target corresponding to the patient's ASCVD risk categorization (defined as follows):ASCVD Primary Prevention (Low Risk): LDL-C ≥ 3.4 mmol/L；ASCVD Primary Prevention (Moderate/High Risk): LDL-C ≥ 2.6 mmol/L；ASCVD Secondary Prevention (Very High Risk): LDL-C ≥ 1.8 mmol/L OR reduction from baseline ≥ 50%；ASCVD Secondary Prevention (Ultra-High Risk): LDL-C ≥ 1.4 mmol/L OR reduction from baseline ≥ 50% 4) Meets the standard clinical criteria for PCSK9 inhibitor initiation, OR the treating physician estimates that continuing current moderate-intensity statins cholesterol absorption inhibitor therapy will not achieve the target LDL-C levels, thereby requiring combination therapy with a PCSK9 inhibitor.

• First-time user of tafolecimab (PCSK9 inhibitor-naïve). 6) Voluntarily participates in the study, provides written informed consent, and meets all follow-up compliance requirements.

• Candidates must meet ALL of the above criteria to be eligible for enrollment in the study.

Exclusion criteria

• Marked liver function abnormalities at enrollment: alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) levels 3 times or more above the upper limit of the normal reference range;
• Renal insufficiency at enrollment: serum creatinine levels above the upper limit of the normal reference range and/or endogenous creatinine clearance below the lower limit of the normal reference range;
• Severe heart failure: left ventricular ejection fraction ≤ 30%;
• Secondary dyslipidemia caused by factors such as thyroid dysfunction, nephrotic syndrome, or familial hyperlipidemia;
• Patients with connective tissue diseases, rheumatic or autoimmune diseases, rhabdomyolysis, hematologic disorders, or malignancies, combined with other types of intracranial diseases;
• Patients who have experienced an allergic reaction while taking oral statins or receiving Tafolecimab injections, as well as those with clear contraindications;
• Patients with a history of major surgery or trauma, or who have developed severe acute or chronic infections during the follow-up period;
• Pregnant women;
• Patients with serious illnesses and a life expectancy of ≤3 months, such as those with malignant tumors;
• Other circumstances deemed unsuitable for participation by the investigators, including any medical or non-medical conditions that may increase the subject's risk, interfere with study assessments, or affect the subject's ability to complete the study.
• Participants meeting any of the above criteria must be excluded.