Prescribing Patterns of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors in Eligible Patients With Clinical Atherosclerotic Cardiovascular Disease or Heterozygous Familial Hypercholesterolemia

Abstract

Two proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors are approved for patients with atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia who require additional low-density lipoprotein cholesterol (LDL-C) lowering. This retrospective study sought to determine differences between eligible patients who were prescribed and those who were not prescribed a PCSK9 inhibitor. Patients from an electronic medical record database were included in the analysis, and their demographic, clinical, and treatment characteristics were evaluated. Of 368,624 PCSK9 inhibitor-eligible patients, 1,752 (<0.5%) received a PCSK9 inhibitor prescription. Patients who received a PCSK9 inhibitor were more frequently associated with a higher cardiovascular disease risk category and a higher baseline LDL-C level (139.4 vs 103.5 mg/dl; p <0.0001) compared with those who did not. Patients with a PCSK9 inhibitor prescription were significantly more likely to be on ezetimibe, alone or in combination with a statin, at baseline compared with those without (29% vs 5%; p <0.0001). The use of a PCSK9 inhibitor was very low in the 2 groups of patients identified as PCSK9 inhibitor-eligible based on the American College of Cardiology Expert Consensus Decision Pathway. In conclusion, this study demonstrates that most PCSK9 inhibitor-eligible patients do not receive a PCSK9 inhibitor prescription, highlighting that many high-risk patients could benefit from additional LDL-C lowering with a PCSK9 inhibitor.

PCSK9 Inhibitors and Neurocognitive Adverse Drug Reactions: Analysis of Individual Case Safety Reports from the Eudravigilance Database

“…In line with our results, the literature suggests that the population treated with these drugs is typically older, often with comorbidities and concomitant medication use [22]. Furthermore, hypercholesterolaemia seems to be more common in women, particularly after menopause, which has been shown to be associated with an increase in total and LDL-cholesterol [32][33][34][35][36][37][38][39]. Lastly, it should be noted that, independently by drug classes, women are more susceptible to experience ADRs due to hormonal factors, as well as changes in pharmacokinetics [40][41][42].…”

Trends in PCSK9 Inhibitor Prescriptions before and after the Price Reduction in Patients with Atherosclerotic Cardiovascular Disease

“…However, prescriptions for a PCSK9 inhibitor remain low. Previous studies using real-world EHR data found that early use of PCSK9 inhibitors was low, with <1% of eligible patients being prescribed a PCSK9 inhibitor [4,13]. Our study provides more current data on the use of PCSK9 inhibitors.…”

“…Despite their safety and cardiovascular benefits, they have been underutilized in clinical practice. In one study among 368,624 PCSK9 inhibitor eligible patients almost 2 years after PCSK9 inhibitors became available, only 1753 (<0.05%) received a PCSK9 inhibitor prescription [4]. The initial cost of these medications was high, with an average cost of over 14,000 USD (US dollars) per year.…”

Statins Versus Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors- Are We Doing Better? A Systematic Review on Treatment Disparity

“…Similarly, Karalis et al illustrated that only 0.5% out of all eligible patients were prescribed PCSK9 inhibitors; and although 41,068 African American patients were eligible to be on PCSK9 inhibitors, only 89 (0.22%) were prescribed this. On the other hand, out of 310,666 white patients that were eligible to be on PCSK9 inhibitors, only 1,602 (0.52%) were prescribed [29]. This confirms the actuality of discrepancies in prescribing PCSK9 inhibitors.…”