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Published on: August 28, 2018
Analysis of Adherence to anti-PCSK9 Antibody Therapy among Patients from Italy
Paolo Mongiello1, Raffaele Petti2, Andrea Ciaccia2
1Specializzando in Farmacia Ospedaliera presso l'Università degli Studi di Bari e tirocinante presso la Struttura Complessa di Farmacia Territoriale dell'Azienda Sanitaria Locale di Foggia, 71121 Foggia, Italy.
Insights
Adherence to PCSK9 inhibitor therapy for hypercholesterolemia is higher in women than men. Young adults (19-49) show the lowest adherence rates for Alirocumab and Evolocumab.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypercholesterolemia is a major risk factor for atherosclerotic cardiovascular disease.
- Statins are standard treatment but often show poor adherence (<50%) and suboptimal outcomes.
- Monoclonal antibodies targeting PCSK9 offer an alternative mechanism for lowering LDL cholesterol.
Purpose of the Study:
- To evaluate therapeutic adherence to PCSK9 inhibitors (Alirocumab and Evolocumab) in a real-world setting.
- To identify patient demographics associated with varying adherence levels.
Main Methods:
- Retrospective analysis of 302 patients receiving Alirocumab or Evolocumab in Foggia, Italy (2021).
- Therapeutic adherence calculated using Medication Possession Ratio (MPR).
- Patients stratified by gender and age groups (0-18, 19-49, 50-64, >65).
Main Results:
- Overall adherence rates were not explicitly stated, but comparisons were made.
- Women demonstrated higher adherence than men for both Alirocumab and Evolocumab.
- Young adults (19-49 years) exhibited the lowest adherence: 69% for Alirocumab and 56% for Evolocumab.
Conclusions:
- Identifying patient groups with low adherence is crucial for targeted interventions.
- Improving adherence to PCSK9 inhibitors can enhance treatment effectiveness and reduce cardiovascular events.
- Specific programs are needed to optimize drug use and achieve treatment goals.
Introduction:
Hypercholesterolemia is one of the main risk factors associated with atherosclerotic cardiovascular disease and coronary heart disease. Statins are the standard cholesterollowering treatment; however, they have shown, in clinical practice, a reduced adherence to therapy (<50%) and a modest achievement of the expected outcomes for treatment. This condition prompt scientific research to develop drugs with different mechanisms of action. In this regard, excellent results have been achieved with therapeutic use of monoclonal antibodies against PCSK9, enzyme involved in recycling of Low density lipoprotein receptors (LDLR) on the hepatocytes surface. Indeed, the reduction in receptor density caused by PCSK9 is associated with increased serum LDL levels.
Materials And Methods:
After the data extraction of all Local Health Authority (ASL) of Foggia patients (302) who received, in 2021, at least one administration of Alirocumab or Evolocumab, the therapeutic adherence was calculated, for each individual patient, by indirect method (calculation of the Medication Possession Ratio - MPR). According to scientific literature, patients were classified into: adherents (MPR>80%), average adherents (MPR between 40% and 80%) and non-adherents (MPR<40%). Patients were then stratified by gender and age groups (0-18, 19-49, 50-64, >65).
Results:
The results show that, for both drugs (Alirocumab and Evolocumab), women are more adherent than men and the group of young adults (19-49 years old) is the one with the lowest adherence to therapy, 69% for Alirocumab and 56% for Evolocumab.
Conclusion:
According to Italian Drug Agency (AIFA), poor therapeutic adherence is the main cause of ineffectiveness of drug therapies, and it is associated with increased hospitalizations, morbidity and mortality. Data obtained from this study allow to detect the categories of patients who need specific programs about the correct use of drugs, in order to increase therapeutic adherence and facilitate the achievement of the expected outcomes for treatment.
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