Punekar Rajeshwari S, Fox Kathleen M, Paoli Carly J, Richhariya Akshara, Cziraky Mark J, Gandra Shravanthi R, Toth Peter P
a HealthCore Inc. , Wilmington , DE , USA.
b Strategic Healthcare Solutions LLC , Aiken , SC , USA.
Curr Med Res Opin. 2017 May;33(5):869-876. doi: 10.1080/03007995.2017.1292898. Epub 2017 Mar 9.
Numerous studies demonstrate that, even with use of statins, many patients are unable to meet their LDL-C goals. This study examined modifications to statin and/or ezetimibe therapy among patients with hyperlipidemia and prior history of cardiovascular (CV) events in a US commercially insured population.
Adults (age ≥18 years) initiating statins and/or ezetimibe between 1 January 2007 and 31 December 2008 were identified from HealthCore Integrated Research Database. The index date was the initiation date of statins and/or ezetimibe. All patients had ≥1 medical claims related to myocardial infarction, unstable angina, ischemic stroke, transient ischemic attack, coronary artery bypass graft, or percutaneous coronary intervention within 12 months prior to the index date. Treatment modifications to statins and/or ezetimibe initiated on the index date (index therapy) included permanent discontinuation of any lipid lowering therapy (LLT), rechallenge, switching, subtraction, augmentation, and dose changes.
Among 17,902 patients, around 90% initiated with statin monotherapy, followed by statin and ezetimibe combination (3.0%: 18-64 years; 3.8%: ≥65 years). Ten percent or less initiated on high intensity statins. Most common treatment modifications were rechallenging index therapy (25.2%: 18-64 years, 27.0%: ≥65 years), switching (27.5%: 18-64 years, 24.6%: ≥65 years), and permanent discontinuation of any LLT (18.6%: 18-64 years, 21.0%: ≥65 years). Only 10% of patients in both groups underwent dose escalation.
Real-world evidence indicates that few high-risk patients initiate therapy with high-intensity statins. More than 50% of patients underwent a rechallenge or switching. Despite high CVD risk profile, approximately 20% of patients permanently discontinued any LLT. Key limitations: Pharmacy claims do not provide information on whether patients who had a pharmacy fill actually took the medication as prescribed. It is unknown whether rechallenge was a simple delay in filling a prescription or an actual rechallenge of their index therapy. Reasons for treatment discontinuations or modifications were unavailable in claims data.
大量研究表明，即便使用他汀类药物，许多患者仍无法达到其低密度脂蛋白胆固醇（LDL-C）目标。本研究在美国商业保险人群中，对高脂血症且有心血管（CV）事件既往史的患者使用他汀类药物和/或依折麦布治疗的调整情况进行了调查。
从HealthCore综合研究数据库中识别出2007年1月1日至2008年12月31日期间开始使用他汀类药物和/或依折麦布的成年人（年龄≥18岁）。索引日期为他汀类药物和/或依折麦布的起始日期。所有患者在索引日期前12个月内有≥1次与心肌梗死、不稳定型心绞痛、缺血性中风、短暂性脑缺血发作、冠状动脉搭桥术或经皮冠状动脉介入治疗相关的医疗索赔。在索引日期开始的对他汀类药物和/或依折麦布的治疗调整（索引治疗）包括永久停用任何降脂治疗（LLT）、再次激发、换药、减量、增量和剂量改变。
在17902例患者中，约90%开始接受他汀类单药治疗，其次是他汀类与依折麦布联合治疗（18 - 64岁：3.0%；≥65岁：3.8%）。10%或更少的患者开始使用高强度他汀类药物。最常见的治疗调整是再次激发索引治疗（18 - 64岁：25.2%；≥65岁：27.0%）、换药（18 - 64岁：27.5%；≥65岁：24.6%）以及永久停用任何LLT（18 - 64岁：18.6%；≥65岁：21.0%）。两组中只有10%的患者进行了剂量增加。
真实世界证据表明，很少有高危患者开始使用高强度他汀类药物进行治疗。超过50%的患者进行了再次激发或换药。尽管心血管疾病风险高，但约20%的患者永久停用了任何LLT。主要局限性：药房索赔未提供关于有药房取药记录的患者是否按处方实际服药的信息。尚不清楚再次激发是简单的处方取药延迟还是对其索引治疗的实际再次激发。索赔数据中没有治疗中断或调整的原因。
