Clinical characteristics and lipid lowering treatment of patients initiated on proprotein convertase subtilisin-kexin type 9 inhibitors: a nationwide cohort study

ObjectivesGiven the novelty of proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i), little is known regarding overall implementation or clinical characteristics among patients who initiate treatment. We aimed to assess the total number of patients initiated on PCSK9i along with a descr...

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Published in:BMJ open 2019-04, Vol.9 (4), p.e022702
Main Authors: Jensen, Jakob Solgaard, Weeke, Peter Ejvin, Bang, Lia Evi, Høfsten, Dan Eik, Ripa, Maria Sejersten, Schjerning, Anne-Marie, Theilade, Juliane Elizabeth, Køber, Lars Valeur, Gislason, Gunnar Hilmar, Pallisgaard, Jannik
Format: Article
Language:English
Subjects:
Aged
Anticholesteremic Agents - therapeutic use
Cardiovascular disease
Cardiovascular Medicine
Cholesterol, LDL - blood
Cohort analysis
Denmark - epidemiology
Diabetes Mellitus - epidemiology
Ezetimibe - therapeutic use
Female
Health risk assessment
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Hypercholesterolemia - drug therapy
Hypercholesterolemia - epidemiology
Inhibitor drugs
Lipids
Male
Middle Aged
Myocardial Ischemia - epidemiology
Practice Patterns, Physicians
Proprotein Convertase 9 - antagonists & inhibitors
Statins
Stroke - epidemiology
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Summary:ObjectivesGiven the novelty of proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i), little is known regarding overall implementation or clinical characteristics among patients who initiate treatment. We aimed to assess the total number of patients initiated on PCSK9i along with a description of the clinical characteristics and lipid lowering treatment (LLT) of such patients.SettingA register-based descriptive cohort study of patients receiving a PCSK9i in the time period from 01 January 2016 to 31 March 2017 using a cross linkage between three nationwide Danish registers. Information regarding PCSK9i prescriptions, patient demographics, concurrent pharmacotherapy, comorbidities and previous coronary procedures was identified.ResultsOverall, 137 patients initiated treatment with PCSK9i in the study period from 11 in the first quarter of 2016 to 40 in the first quarter of 2017. The majority had a history of ischaemic heart disease (IHD) (67.9%) with ischaemic stroke and diabetes mellitus being present in 7.3% and 16.8% of patients, respectively. All patients initiated on PCSK9i had been previously prescribed statin treatment with atorvastatin and simvastatin being most frequently prescribed in 53% and 36% of patients, respectively. The majority of patients had received both statins and ezetimibe (94.9%) and approximately half of these patients had also received bile acid sequestrant (45.3%). Clinical characteristics mainly differed in patients receiving triple LLT compared with patients not receiving triple LLT in the regards of heart failure.ConclusionPatients treated with PCSK9i were rare, characterised by having IHD and had received various and intensive conventional LLT prior to PCSK9i initiation in agreement with current international guidelines.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2018-022702