1 research outputs found
Association of PCSK9 Inhibitor Initiation on Statin Adherence and Discontinuation
Background PCSK9is (proprotein convertase subtilisin/kexin type 9 inhibitors) are well tolerated, potently lower cholesterol, and decrease cardiovascular events when added to statins. However, statin adherence may decrease after PCSK9i initiation and alter clinical outcomes. We evaluate the association of PCSK9i initiation on statin discontinuation and adherence. Methods and Results In this retrospective preâpost differenceâinâdifference analysis, new PCSK9i claims were propensity matched with statinâalone users (April 2017âSeptember 2019). The primary outcomes were statin adherence (proportion of days covered) and statin discontinuation (absence of statin coverage for at least 60âdays) 12âmonths following PCSK9i initiation. Secondary outcomes included lowâdensity lipoprotein cholesterol levels after 1âyear. A total of 220â538 statin users and 700 PCSK9i users were identified, from which 178 on PCSK9i were included and matched to 712 on statins alone. At 12âmonths, mean statin proportion of days covered decreased from 67% to 48% in the PCSK9i group but increased from 68% to 86% in the statinâalone groups (P<0.0001). Statin discontinuation rates increased from 11% to 39% in the PCSK9i group and from 7% to 9% in the statinâalone group (P=0.0041). Patients with lowâdensity lipoprotein cholesterol <70âmg/dL increased from 5% to 68% with PCSK9i but increased from 16% to 24% with statins alone (P<0.0001). Changes in hospitalization rates were similar between both groups during the followâup period. Conclusions PCSK9i initiation was associated with decreased lowâdensity lipoprotein cholesterol, higher statin discontinuation, and reduced statin adherence