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PCSK9 Inhibitor Use and Outcomes Using Concomitant Lipid-Lowering Therapies in the Veterans Health Administration.

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Veterans demonstrated good adherence to PCSK9 inhibitors (PCSK9-Is). Combining PCSK9 inhibitors with statins and/or ezetimibe significantly lowered low-density lipoprotein (LDL) levels compared to monotherapy.

Keywords:
AdherenceAlirocumabEvolocumabHyperlipidemiaLDL

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Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Real-World Evidence

Background:

  • Real-world data on PCSK9 inhibitors (PCSK9-Is) use is crucial for optimizing prescribing practices.
  • Evaluating the clinical effectiveness and safety of PCSK9-Is in the Veterans Health Administration (VHA) is essential.

Purpose of the Study:

  • To assess the effectiveness and safety of PCSK9 inhibitors within the VHA.
  • To compare outcomes of PCSK9 inhibitor monotherapy versus combination therapy with statins and/or ezetimibe.

Main Methods:

  • Retrospective cohort study of Veterans prescribed alirocumab and/or evolocumab between August 2015 and September 2020.
  • Analysis of four mutually exclusive subgroups: PCSK9-I alone, PCSK9-I+statin, PCSK9-I+ezetimibe, and PCSK9-I+statin+ezetimibe.
  • Primary outcomes included medication possession ratio, persistence, and low-density lipoprotein (LDL) levels.

Main Results:

  • Good medication possession ratios (83.8%–87.1%) and persistence were observed across all PCSK9 inhibitor (PCSK9-I) subgroups.
  • PCSK9-I monotherapy had a higher discontinuation rate (12.3%) compared to combination therapies (6.6%–9.5%).
  • Mean LDL levels were significantly lower in patients receiving concomitant statin and/or ezetimibe (65.7–68.1 mg/dL) versus PCSK9-I monotherapy (85.6 mg/dL).

Conclusions:

  • Veterans exhibit favorable adherence and persistence with PCSK9 inhibitor regimens.
  • Concomitant use of statins and/or ezetimibe with PCSK9 inhibitors leads to superior LDL reduction.
  • Combination therapy may enhance treatment effectiveness and potentially improve long-term cardiovascular outcomes.