Donald Dustin R, Reynolds Victoria W, Hall Nicole, DeClercq Josh, Choi Leena
Specialty Pharmacy Services, Vanderbilt University Medical Center, 726 Melrose Avenue Nashville, TN 37211, United States.
Specialty Pharmacy Services, Vanderbilt University Medical Center, 726 Melrose Avenue Nashville, TN 37211, United States.
J Clin Lipidol. 2022 May-Jun;16(3):315-324. doi: 10.1016/j.jacl.2022.03.004. Epub 2022 Mar 19.
Nearly 40% of patients do not continue proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) therapy after 6 months, despite their ability to lower low-density lipoprotein cholesterol (LDL-C) and risk of cardiovascular events. Limited work has assessed persistence to PCSK9i therapy in an integrated specialty pharmacy model.
To assess rates of persistence to PCSK9i therapy and report reasons for non-persistence in patients serviced within an integrated specialty pharmacy.
We conducted a single-center, retrospective review of patients prescribed a PCSK9i at an academic health system between September 2015 and August 2018. Persistence was calculated as a binary measure (yes/no) of whether the patient was still receiving PCSK9i therapy at 3-, 12-, and 24-months; frequency distributions described reasons for non-persistence and descriptive statistics described the change in LDL-C from baseline to 24 months.
477 patients met inclusion criteria, 53% were male with median age of 63 years [IQR 56-70]. Median LDL-C at baseline was 157mg/dL and 86% had an atherosclerotic cardiovascular disease indication. Persistence at 3-, 12-, and 24-months was 94%, 80%, and 68%, respectively. Of the 262 patients persistent on PCSK9i therapy at 24 months with LDL-C values available, median LDL-C was 65 mg/dL. The most common reasons for non-persistence at 24 months included medication adverse effects (54%) and loss to follow-up (17%).
High rates of persistence to PCSK9i were seen in patients receiving care within an integrated specialty pharmacy model compared with rates in previous studies, suggesting specialty pharmacists may play a role in mitigating many common reasons for PCSK9i non-persistence.
尽管前蛋白转化酶枯草溶菌素9型抑制剂（PCSK9i）有降低低密度脂蛋白胆固醇（LDL-C）及心血管事件风险的能力，但近40%的患者在6个月后未继续接受PCSK9i治疗。在综合专科药房模式下，评估PCSK9i治疗持续性的研究工作有限。
评估综合专科药房服务的患者中PCSK9i治疗的持续性，并报告未持续治疗的原因。
我们对2015年9月至2018年8月在一家学术医疗系统中开具PCSK9i处方的患者进行了单中心回顾性研究。持续性以二元指标（是/否）计算，即患者在3个月、12个月和24个月时是否仍在接受PCSK9i治疗；频率分布描述未持续治疗的原因，描述性统计描述从基线到24个月LDL-C的变化。
477例患者符合纳入标准，53%为男性，中位年龄63岁[四分位间距56 - 70]。基线时LDL-C中位数为157mg/dL，86%有动脉粥样硬化性心血管疾病指征。3个月、12个月和24个月时的持续性分别为94%、80%和68%。在24个月时持续接受PCSK9i治疗且有LDL-C值的262例患者中，LDL-C中位数为65mg/dL。24个月时未持续治疗的最常见原因包括药物不良反应（54%）和失访（17%）。
与以往研究相比，在综合专科药房模式下接受治疗的患者中，PCSK9i的持续性较高，这表明专科药师可能在减轻PCSK9i未持续治疗的许多常见原因方面发挥作用。
