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Aim  To evaluate the safety of the proprotein convertase subtilisin/kexin type 9 ( PCSK 9) inhibitor alirocumab according to diabetes mellitus status.    Methods  Safety data from 14 trials (8–104‐week durations) were analysed by treatment (alirocumab or placebo/ezetimibe control) and diabetes status (yes/no, defined by medical history). Adverse event data were assessed using descriptive statistics and Cox models.    Results  Of the 5234 trial participants, 1554 (29.7%) had diabetes. Overall, treatment‐emergent adverse events were similar in the alirocumab and control groups, except for more frequent local injection site reactions with alirocumab. Fewer people with diabetes experienced local injection site reactions [alirocumab, 3.5%, control, 2.9%; hazard ratio 1.24 (95%  CI  0.68–2.25)] than those without diabetes [alirocumab, 7.5%; control, 4.9%; hazard ratio 1.51 (95%  CI  1.13–2.01)]. Those with diabetes reported a greater number of serious adverse events (alirocumab, 19.4%; control, 19.7%) than those without diabetes (alirocumab, 14.5%; control, 13.5%). In people with diabetes, major adverse cardiac events occurred in 2.7% of alirocumab‐treated people [control, 3.3%; hazard ratio 0.74 (95%  CI  0.41–1.35)]; in those without diabetes, 1.8% of alirocumab‐treated people had major adverse cardiac events [control, 1.7%; hazard ratio 0.95 (95%  CI  0.56–1.62)]. Overall, no increase in HbA 1c  or fasting plasma glucose vs control treatment groups was observed, regardless of diabetes status.    Conclusion  This pooled analysis across 14 trials demonstrated similar safety for alirocumab vs control treatment, irrespective of diabetes status, except for more frequent local injection site reactions with alirocumab. People with diabetes reported fewer local injection site reactions than those without diabetes.

Alirocumab safety in people with and without diabetes mellitus: pooled data from 14 ODYSSEY trials