Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
J Clin Lipidol. 2021 Mar-Apr;15(2):339-346. doi: 10.1016/j.jacl.2020.12.009. Epub 2020 Dec 27.
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were approved in August 2015 as an adjunct to maximally tolerated statin treatment in those with familial hypercholesterolemia (FH).
To assess PCSK9 inhibitor utilization patterns and cholesterol control in the high-risk FH population.
This study was a retrospective analysis of a large administrative database that includes privately insured and Medicare Advantage patients. Individuals with diagnosis codes for FH from October 2016-September 2019 were identified. Differences in PCSK9 inhibitor utilization between various groups were evaluated using multivariable logistic regression.
During the study period, 1:371 people enrolled in medical/pharmacy plans had a diagnosis of FH. While 62.5% (n = 33,649) had medication fills for statins (without PCSK9 inhibitors), only 2.0% (n = 1062) had medication fills for PCSK9 inhibitors (with or without other medications). Compared to men, women were more likely to be untreated (OR 1.23, 95% confidence interval (CI):1.18-1.28, p < 0.01) but more likely to be treated with PCSK9 inhibitors (OR 2.18, 95%CI:1.90-2.49, p < 0.01). Compared to those younger than 55 years of age, older individuals were more likely to be treated (OR 1.64, 95%CI:1.56-1.72, p < 0.01) but less likely to be treated with PCSK9 inhibitors (OR 0.40, 95%CI:0.34-0.47, p < 0.01). Lastly, those with household incomes ≥$40,000 were more likely to be treated with PCSK9 inhibitors than those with lower household incomes (OR 1.69, 95%CI:1.41-2.02, p < 0.01).
PCSK9 inhibitor utilization in FH remains low. Significant differences exist based on demographic factors. Female sex, higher household incomes, and younger age were associated with increased PCSK9 inhibitor utilization.
2015 年 8 月，批准了前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂作为家族性高胆固醇血症（FH）患者最大耐受他汀类药物治疗的辅助药物。
评估 PCSK9 抑制剂在高危 FH 人群中的使用模式和胆固醇控制情况。
本研究是对一个大型行政数据库的回顾性分析，该数据库包括私人保险和医疗保险优势计划的患者。2016 年 10 月至 2019 年 9 月期间，根据 FH 的诊断代码识别出患者。使用多变量逻辑回归评估不同组之间 PCSK9 抑制剂使用的差异。
在研究期间，每 371 名参加医疗/药房计划的人中就有 1 人被诊断为 FH。尽管 62.5%（n=33649）有他汀类药物（无 PCSK9 抑制剂）的用药记录，但只有 2.0%（n=1062）有 PCSK9 抑制剂（有或无其他药物）的用药记录。与男性相比，女性未接受治疗的可能性更高（比值比 1.23，95%置信区间[CI]：1.18-1.28，p<0.01），但更有可能接受 PCSK9 抑制剂治疗（比值比 2.18，95%CI：1.90-2.49，p<0.01）。与 55 岁以下的人相比，年龄较大的人更有可能接受治疗（比值比 1.64，95%CI：1.56-1.72，p<0.01），但更不可能接受 PCSK9 抑制剂治疗（比值比 0.40，95%CI：0.34-0.47，p<0.01）。最后，家庭收入≥$40000 的人比家庭收入较低的人更有可能接受 PCSK9 抑制剂治疗（比值比 1.69，95%CI：1.41-2.02，p<0.01）。
FH 中 PCSK9 抑制剂的使用仍然很低。基于人口统计学因素存在显著差异。女性、高家庭收入和年轻是增加 PCSK9 抑制剂使用的相关因素。
