A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels
Background: Treatment with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduces low-density lipoprotein cholesterol (LDL-C) levels and decreases the incidence of major ischaemic events in clinical trials. However, less is known about the efficacy of PCSK9 inhibition in clinical p...
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| Format: | Article |
| Language: | English |
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Upsala Medical Society
2024-01-01
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| Series: | Upsala Journal of Medical Sciences |
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| Online Access: | https://ujms.net/index.php/ujms/article/view/9618/16831 |
| _version_ | 1797324055905304576 |
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| author | Maria K. Svensson Stefan James Annica Ravn-Fischer Guillermo Villa Lovisa Schalin Thomas Cars Stefan Gustafsson Emil Hagström |
| author_facet | Maria K. Svensson Stefan James Annica Ravn-Fischer Guillermo Villa Lovisa Schalin Thomas Cars Stefan Gustafsson Emil Hagström |
| author_sort | Maria K. Svensson |
| collection | DOAJ |
| description | Background: Treatment with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduces low-density lipoprotein cholesterol (LDL-C) levels and decreases the incidence of major ischaemic events in clinical trials. However, less is known about the efficacy of PCSK9 inhibition in clinical practice. This study aimed to describe the change in LDL-C levels over time and LDL-C goal achievement in patients with/without atherosclerotic cardiovascular disease (ASCVD), who were prescribed evolocumab in clinical practice, and to describe adherence to and persistence with treatment. Methods: Patients in Sweden with at least one evolocumab prescription filled between July 2015 and May 2020 were included. Medical history and lipid-lowering therapy (LLT) were sourced from national registries. LDL-C levels before and after treatment initiation were assessed using medical records. Persistence with and adherence to evolocumab and oral LLT were assessed up to 12 months after treatment initiation using the refill-gap method and proportion of days covered, respectively. Results: Of the 2,360 patients with at least one prescription for evolocumab, 2,341 were included; 1,858 had ASCVD. Persistence with (76%) and adherence to (86%) evolocumab were high throughout the 12 months following initiation. Mean LDL-C levels decreased by 53% (95% confidence interval [CI]: 51–55%) in patients adherent to evolocumab (n = 567) and 59% (95% CI: 55–63%) in patients adherent to evolocumab and oral LLT (n = 186). Similar reductions in LDL-C were observed in patients with/without ASCVD. Reduced LDL-C levels remained stable during follow-up. Amongst patients adherent to evolocumab and those adherent to evolocumab and oral LLT, 23 and 55% achieved the LDL-C goal of <1.4 mmol/L, respectively. Conclusions: The evolocumab LDL-C-lowering effect observed in clinical trials was confirmed in clinical practice in Sweden, particularly in patients also treated with oral LLT. During follow-up, adherence to and persistence with evolocumab were high, with stable reduced levels of LDL-C during observation. |
| first_indexed | 2024-03-08T05:44:44Z |
| format | Article |
| id | doaj.art-6a82235f13f94afb98a696585deb3a07 |
| institution | Directory Open Access Journal |
| issn | 0300-9734 2000-1967 |
| language | English |
| last_indexed | 2024-03-08T05:44:44Z |
| publishDate | 2024-01-01 |
| publisher | Upsala Medical Society |
| record_format | Article |
| series | Upsala Journal of Medical Sciences |
| spelling | doaj.art-6a82235f13f94afb98a696585deb3a072024-02-05T14:13:01ZengUpsala Medical SocietyUpsala Journal of Medical Sciences0300-97342000-19672024-01-0112911010.48101/ujms.v129.96189618A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levelsMaria K. Svensson0Stefan James1Annica Ravn-Fischer2Guillermo Villa3Lovisa Schalin4Thomas Cars5Stefan Gustafsson6Emil Hagström7Department of Medical Sciences, Uppsala University, Uppsala, SwedenDepartment of Medical Sciences, Uppsala University, Uppsala, SwedenDepartment of Cardiology, Sahlgrenska University Hospital, Gothenburg, SwedenHealth Economics & Outcomes Research, Amgen (Europe) GmbH, Rotkreuz, SwitzerlandMedical Affairs, Amgen AB, Stockholm, SwedenSence Research, Uppsala, SwedenSence Research, Uppsala, SwedenDepartment of Medical Sciences, Uppsala University, Uppsala, SwedenBackground: Treatment with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduces low-density lipoprotein cholesterol (LDL-C) levels and decreases the incidence of major ischaemic events in clinical trials. However, less is known about the efficacy of PCSK9 inhibition in clinical practice. This study aimed to describe the change in LDL-C levels over time and LDL-C goal achievement in patients with/without atherosclerotic cardiovascular disease (ASCVD), who were prescribed evolocumab in clinical practice, and to describe adherence to and persistence with treatment. Methods: Patients in Sweden with at least one evolocumab prescription filled between July 2015 and May 2020 were included. Medical history and lipid-lowering therapy (LLT) were sourced from national registries. LDL-C levels before and after treatment initiation were assessed using medical records. Persistence with and adherence to evolocumab and oral LLT were assessed up to 12 months after treatment initiation using the refill-gap method and proportion of days covered, respectively. Results: Of the 2,360 patients with at least one prescription for evolocumab, 2,341 were included; 1,858 had ASCVD. Persistence with (76%) and adherence to (86%) evolocumab were high throughout the 12 months following initiation. Mean LDL-C levels decreased by 53% (95% confidence interval [CI]: 51–55%) in patients adherent to evolocumab (n = 567) and 59% (95% CI: 55–63%) in patients adherent to evolocumab and oral LLT (n = 186). Similar reductions in LDL-C were observed in patients with/without ASCVD. Reduced LDL-C levels remained stable during follow-up. Amongst patients adherent to evolocumab and those adherent to evolocumab and oral LLT, 23 and 55% achieved the LDL-C goal of <1.4 mmol/L, respectively. Conclusions: The evolocumab LDL-C-lowering effect observed in clinical trials was confirmed in clinical practice in Sweden, particularly in patients also treated with oral LLT. During follow-up, adherence to and persistence with evolocumab were high, with stable reduced levels of LDL-C during observation.https://ujms.net/index.php/ujms/article/view/9618/16831adherenceevolocumabldl-cpcsk9 inhibitorspersistencereal-world evidence |
| spellingShingle | Maria K. Svensson Stefan James Annica Ravn-Fischer Guillermo Villa Lovisa Schalin Thomas Cars Stefan Gustafsson Emil Hagström A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels Upsala Journal of Medical Sciences adherence evolocumab ldl-c pcsk9 inhibitors persistence real-world evidence |
| title | A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels |
| title_full | A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels |
| title_fullStr | A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels |
| title_full_unstemmed | A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels |
| title_short | A retrospective nationwide analysis of evolocumab use in Sweden and its effect on low-density lipoprotein cholesterol levels |
| title_sort | retrospective nationwide analysis of evolocumab use in sweden and its effect on low density lipoprotein cholesterol levels |
| topic | adherence evolocumab ldl-c pcsk9 inhibitors persistence real-world evidence |
| url | https://ujms.net/index.php/ujms/article/view/9618/16831 |
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