OBJECTIVE  To evaluate the efficacy and safety of evolocumab and alirocumab on the treatment of acute coronary syndrome(ACS).

METHODS  Retrieve randomized controlled trials(RCTs) of evolocumab and alirocumab for the treatment of ACS that have been publicly published both domestically and internationally, with a search period from database establishment to June 2023. Used Stata 15 software to conduct a network meta-analysis to compare the efficacy and safety of evolocumab and alirocumab.

RESULTS  A total of 22 RCTs, involving 22339 patients were included. The drugs in the experimental group included statins combined with either evolocumab or alirocumab, and the control group was statins or statins combined with placebo. In terms of effectiveness, on the basis of statins, there was no significant difference in the reduction of LDL-C, TG, TC, hs-CRP levels and improvement of HDL-C metabolism between evolocumab and alirocumab. In terms of safety, there was no significant difference in the incidence of cardiovascular adverse events between the two drugs.

CONCLUSION  In the ACS population, statin combined with evolocumab or alirocumab significantly improve lipid metabolism and reduce the incidence of adverse cardiovascular events. There is no significant difference in the incidence of efficacy and safety between the evolocumab or alirocumab. However, this conclusion still needs to be validated through a large number of multicenter and large sample RCTs.