Chen Wen-Jone, Wen Yao-Chun, Fox Kathleen M, Shen Li-Jiuan, Lin Lian-Yu, Qian Yi, Zhao Zhongyun, Rane Pratik P, Hsiao Fei-Yuan
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Health Data Research Center, National Taiwan University, Taipei, Taiwan.
J Eval Clin Pract. 2020 Aug;26(4):1171-1180. doi: 10.1111/jep.13286. Epub 2019 Oct 23.
To assess treatment patterns of statin and/or ezetimibe and possible statin intolerance among patients initiating statin or statin plus ezetimibe and with clinical atherosclerotic cardiovascular disease (ASCVD) or diabetes mellitus (DM) in Taiwan.
A retrospective cohort study using Taiwan's 2005 to 2013 National Health Insurance Research Database (NHIRD) was conducted. Patients with history of clinical ASCVD or DM (without previous clinical ASCVD) and initiating statin or statin plus ezetimibe therapy during 2006 to 2012 were identified. The treatment initiation date was defined as index date. Treatment patterns (including discontinuation, reinitiation, subtraction, switching, and augmentation), adherence (medication possession ratio [MPR]), persistence (gap no greater than 60 d) of statin and/or ezetimibe, and possible statin intolerance during 12-month follow-up from the index date were examined.
Among patients initiating statin or statin plus ezetimibe, 11 092 patients with history of clinical ASCVD and 31 100 patients with DM but without clinical ASCVD were analysed. The discontinuation, reinitiation, and switching rates among patients with clinical ASCVD were 54.0%, 11.3%, and 25.7% during 12-month follow-up period, respectively. Among patients with DM, the rates were 57.5%, 14.2%, and 28.5%. The MPRs of statin among clinical ASCVD and DM cohorts were 0.62 and 0.60, respectively. As for ezetimibe, the MPRs were 0.56 and 0.59. Persistence to statin treatment was 46.1% among ASCVD patients and 42.6% among DM patients. Among the ASCVD and DM cohorts, possible statin intolerance was observed among 19.9% and 21.4% of patients, respectively.
Large number of patients with either ASCVD or DM discontinued lipid-lowering therapies with suboptimal adherence and persistence among Taiwanese population. There is a large unmet medical need to provide safe and more effective therapies, which can be used in combination with statins or alone, to reduce the risk of CV events and improve outcomes in high-risk patients.
评估台湾地区开始使用他汀类药物和/或依泽替米贝治疗的患者的治疗模式以及可能存在的他汀类药物不耐受情况，这些患者患有临床动脉粥样硬化性心血管疾病（ASCVD）或糖尿病（DM），并开始使用他汀类药物或他汀类药物联合依泽替米贝治疗。
利用台湾地区2005年至2013年全民健康保险研究数据库（NHIRD）进行一项回顾性队列研究。确定有临床ASCVD病史或DM（既往无临床ASCVD）且在2006年至2012年期间开始使用他汀类药物或他汀类药物联合依泽替米贝治疗的患者。将治疗开始日期定义为索引日期。研究从索引日期开始的12个月随访期间他汀类药物和/或依泽替米贝的治疗模式（包括停药、重新开始用药、减量、换药和增量）、依从性（药物持有率[MPR]）、持续性（间隔不超过60天）以及可能存在的他汀类药物不耐受情况。
在开始使用他汀类药物或他汀类药物联合依泽替米贝治疗的患者中，分析了11092例有临床ASCVD病史的患者和31100例有DM但无临床ASCVD的患者。在12个月随访期内，临床ASCVD患者的停药率、重新开始用药率和换药率分别为54.0%、11.3%和25.7%。DM患者的这些比率分别为57.5%、14.2%和28.5%。临床ASCVD队列和DM队列中他汀类药物的MPR分别为0.62和0.60。至于依泽替米贝，MPR分别为0.56和0.59。ASCVD患者中他汀类药物治疗的持续性为46.1%，DM患者中为42.6%。在ASCVD队列和DM队列中，分别有19.9%和21.4%的患者观察到可能存在他汀类药物不耐受情况。
在台湾人群中，大量患有ASCVD或DM的患者停止了降脂治疗，依从性和持续性欠佳。迫切需要提供安全且更有效的治疗方法，这些方法可与他汀类药物联合使用或单独使用，以降低心血管事件风险并改善高危患者的预后。
