Graf Marlon, Khera Amit V, May Suepattra G, Chung Sukyung, N'dri Laetitia, Cristino Joaquim, Electricwala Batul
Precision AQ, Bethesda, MD, USA.
Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
Heliyon. 2024 Aug 8;10(16):e35990. doi: 10.1016/j.heliyon.2024.e35990. eCollection 2024 Aug 30.
Approximately 80 % of patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve the guideline-based target for low-density lipoprotein (LDL-C) levels in current clinical practice, particularly the 95 % of ASCVD patients receiving oral statin monotherapy. The objective was to determine physician prescribing preferences for LDL-C lowering therapies beyond statins for patients with ASCVD.
A discrete choice experiment (DCE) survey was administered to cardiologists and primary care physicians in the United States, presenting a series of treatment choices systematically varied across 8 treatment attributes: % LDL-C reduction, myalgias, other side effects, route and frequency of administration, time to prior authorization, patient monthly out-of-pocket cost (mOOP), and adherence. Data were analyzed using logistic regression to estimate preference weights for each attribute.
A total of 200 cardiologists and 50 primary care physicians (PCPs) completed the survey. Both exhibited similar prescribing preferences, highly valuing efficacy in reducing LDL-C levels and minimization of patients OOP cost. Each additional 10 % reduction in LDL-C was associated with a 69 % relative increase in physician preference. By contrast, a 10 % relative decrease in preference was observed for each $10 additional monthly mOOP. Compared to PCPs, cardiologists tended to place more emphasis on LDL-C reduction, being more willing to accept higher mOOP or side effects. Although oral therapies were preferred, injectable therapies, like the PCSK9 siRNA-like drug, administered less frequently that allowed for greater LDL-C reduction were seen as having considerable utility, especially among patients with a history of medication nonadherence.
These results document considerable preference similarities among cardiologist and PCP prescribers of LDL-C lowering therapies for ASCVD. Broad availability of several therapies with varying administration frequencies and product profiles are likely of great value to prescribing physicians aiming to achieve target LDL-C concentrations. Considering all aspects of treatment, most participants preferred a PCSK9 siRNA-like drug.
在当前临床实践中，约80%的动脉粥样硬化性心血管疾病（ASCVD）患者未达到基于指南的低密度脂蛋白（LDL-C）水平目标，尤其是95%接受口服他汀类单药治疗的ASCVD患者。目的是确定医生对于ASCVD患者除他汀类药物外的LDL-C降低疗法的处方偏好。
对美国的心脏病专家和初级保健医生进行了一项离散选择实验（DCE）调查，呈现了一系列在8个治疗属性上系统变化的治疗选择：LDL-C降低百分比、肌痛、其他副作用、给药途径和频率、预先授权时间、患者每月自付费用（mOOP）以及依从性。使用逻辑回归分析数据以估计每个属性的偏好权重。
共有200名心脏病专家和50名初级保健医生（PCP）完成了调查。两者表现出相似的处方偏好，高度重视降低LDL-C水平的疗效以及将患者的自付费用降至最低。LDL-C每额外降低10%，医生偏好相对增加69%。相比之下，每月mOOP每增加10美元，偏好相对降低10%。与初级保健医生相比，心脏病专家倾向于更强调降低LDL-C，更愿意接受更高的mOOP或副作用。尽管口服疗法更受青睐，但注射疗法，如PCSK9 siRNA类药物，给药频率较低但能实现更大程度的LDL-C降低，被认为具有相当大的效用，尤其是在有药物不依从病史的患者中。
这些结果表明，在为ASCVD患者开具LDL-C降低疗法的心脏病专家和初级保健医生处方者之间存在相当大的偏好相似性。对于旨在达到目标LDL-C浓度的开处方医生来说，广泛提供几种给药频率和产品特征各异的疗法可能具有很大价值。考虑到治疗的各个方面，大多数参与者更喜欢PCSK9 siRNA类药物。
