Both PCSK9 inhibitors ans Statins are very powerful LDL-C lowering drugs. To start with, the JUPITER trial reported a 25% increase in NOD with rosuvastatin 20 mg, over a median follow-up of 1.9 years, compared to placebo and since then, several meta-analyses have confirmed a smaller but significant increase with various statins . Several mechanisms have been postulated underlying the derangement in glucose metabolism by statins. There is some evidence for the detrimental effects of statins on both insulin sensitivity and β cell secretion including the effects of increased influx of cholesterol due to inhibition of HMG-CoA-mediated intracellular cholesterol synthesis, inhibition of CoQ 10 and β cell apoptosis. Also one hypothesis states that lower levels of LDL-C can interfere with optimal β cell function. PCSK9 inhibitors are more powerful LDL-C lowering agents, then why only statins have been implicated in causing NOD and most of the studies done with PCSK9 inhibitors show no association. Is it for some commercial gain to make PCSK9 inhibitors, more popular LDL-C lowering agents?
As you have rightly pointed the possible commercial explanation as the statin have now became generic and there is a need for one patented drug for business. This could be one of the factor. The same story of pioglitazine causing urinary bladder cancer created fear in prescribing physician and to change over to gliptins even though gliptins side effects or adverse events were more.
In order to prove it is better than available statins they willfully avoided few inclusion criteria in selected studies.
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