Author + information
- Machaon Bonafedea,b,
- Lorena Lopez-Gonzaleza,b,
- Pallavi Ranea,b,
- Jeetvan Patela,b and
- David Harrisona,b
Background: Evolocumab and alirocumab are proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) approved in 2015 to be used along with diet and maximally tolerated statin therapy in adults with clinical atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia requiring additional lowering of low-density lipoprotein cholesterol. The goal of this study is to describe demographic and clinical characteristics of early adopters of PCSK9i therapy.
Methods: This retrospective study identified adults (>18 years) in the MarketScan Commercial Claims and Encounters, Medicare Supplemental and Early View Databases with ≥1 claim for evolocumab or alirocumab between 8/1/2015 and 5/31/2016. Patients were required to be enrolled for 180 days prior to their first (index) PCSK9i claim. Demographics, recent cardiovascular events (CV), and prior use of lipid-lowering therapy was assessed pre-index.
Results: There were 1,454 PCSK9i initiators, of which 840 patients (417 evolocumab; 423 alirocumab) had ≥90 days of continuous enrollment following initiation. Demographics were similar for both agents; mean age 61.2 (SD 9.8), 57.3% were male, 69.3% had commercial health insurance, and 29.0% received their prescription from a cardiologist. Pre-index, 24.9% used statin monotherapy, 12.7% ezetimibe monotherapy, and 21.1% both a statin and ezetimibe. The vast majority of patients using a statin, (81.3% monotherapy; 91.7% combination) were on a moderate or high intensity statin. The most common comorbidities were hypertension (67.9%) and diabetes (27.5%). CV events in the past 180 days were common and similar for both agents; 16.4% had a claim for stable or unstable angina, 11.5% for myocardial infarction, 12.7% for a revascularization procedure, 9.8% for carotid stenosis, and 9.9% for peripheral vascular disease. Only 2.6 % had a claim for ischemic stroke.
Conclusions: Recent CV events were common among early adopters of PCSK9i. Statin use was seen in nearly one-half of the patients, and of those over 84% were on a high or moderate intensity statin. Patients without recent statin use may have had a history of statin intolerance that could not be ascertained in claims.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Diabetes and Other Issues in Cardiovascular Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1277-065
- 2017 American College of Cardiology Foundation