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Background: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with premature atherosclerotic cardiovascular disease. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have shown reductions in LDL-C levels in patients uncontrolled by statin and/or ezetimibe therapy. The goal of this study was to assess persistence and adherence in early initiators of PCSK9i.
Methods: The IMS longitudinal prescription claims database (LRx) was used to identify patients who initiated evolocumab or alirocumab between 8/1/2015 and 1/31/2016. The date of the first fill marked the index date, at which time the patients’ demographic information was assessed. Patients were followed for at least 6 months post-index, during which time persistence and adherence were assessed. A 30-day gap was used to define non-persistence. Adherence was reported as proportion of days covered (PDC), which is the total number of days supply of the medication divided by the time from the first claim to the end of days supply on the last claim.
Results: A total of 4,853 patients initiated a PCSK9i during the study period, and had mean (SD) age of 63.8 (10.9) years. Patients initiating evolocumab (n = 2,834) were similar to those initiating alirocumab (n=2,019); mean (SD) age 64.5 (11.1) vs. 62.9 (10.6) years and 51% vs 54% were male, respectively. Overall, 60.4% of PCSK9i users had commercial health insurance, and 31.1% had commercial Medicare insurance. The majority (55%) received their index PCSK9i prescription from cardiologists. Mean (SD) duration of therapy was 119.4 (80.9) days. The overall mean (SD) PDC was 0.57 (0.32) for all PCSK9i users. When stratified by payer type, the mean (SD) PDC was higher for patients with commercial insurance (0.62 [0.32]) as compared to those with Medicare (0.54 [0.31]).
Conclusions: Adherence as assessed by PDC was lower for Medicare than in commercial insurance. Further research is needed to understand the reasons for lower adherence in Medicare and what impact the “donut hole” and limited availability of copay assistance in Medicare may have on this result.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in Lipid Management
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1203-313
- 2017 American College of Cardiology Foundation