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PCSK9 inhibitors use in clinical practice: a tertiary hospital experience

Session Poster Session 2

Speaker Lorena Martin Polo

Congress : EuroPrevent 2019

  • Topic : preventive cardiology
  • Sub-topic : Lipids
  • Session type : Poster Session
  • FP Number : P562

Authors : L Martin Polo (Madrid,ES), I Marco Clement (Madrid,ES), R Dalmau Gonzalez-Gallarza (Madrid,ES), C Merino Argos (Madrid,ES), A Rivas Perez (Madrid,ES), A Velez Salas (Madrid,ES), LA Martinez Marin (Madrid,ES), L Rodriguez Sotelo (Madrid,ES), JM Garcia De Veas Marquez (Madrid,ES), A Castro Conde (Madrid,ES), JL Lopez-Sendon Hentschel (Madrid,ES)

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Authors:
L Martin Polo1 , I Marco Clement1 , R Dalmau Gonzalez-Gallarza1 , C Merino Argos1 , A Rivas Perez1 , A Velez Salas1 , LA Martinez Marin1 , L Rodriguez Sotelo1 , JM Garcia De Veas Marquez1 , A Castro Conde1 , JL Lopez-Sendon Hentschel1 , 1University Hospital La Paz, Cardiac Rehabilitation - Madrid - Spain ,

Citation:

Background: Lipid control goals are difficult to reach in clinical practice. According to several registries, less than 30% of the secondary prevention patients have a level of LDL-c<70mg/dl. PCSK9 inhibitors (PCSK9i) have been proven to be a safe and effective treatment, however their implementation is limited by their cost and reimbursement limitations.

Purpose: We analyse the barriers to the prescription of PCSK9i in a public tertiary hospital in Spain.

Methods: In our hospital a multidisciplinary committee reviews all PCSK9i prescriptions. Eligible patients include those with LDL-c>100mg/dl in secondary prevention or with proven familial hypercholesterolemia despite optimal therapy (maximum tolerated statin dose and ezetimibe) or proven statin intolerance. Once accepted, patients are randomly assigned to receive evolocumab or alirocumab which they retrieve from the hospital pharmacy every two months. We reviewed all requests for PCSK9i administration between October 2016 and May 2018.

Results: We recorded demands for PCSK9i prescription in 91 patients during a 20-month period. Baseline characteristics are shown in table 1. Seventy-four PCSK9i solicitudes (81.3%) were accepted and 17 (18.7%) were denied (13 did not meet clinical criteria, 2 had LDL-c<100mg/dl and 2 were not under optimal therapy). Among the accepted patients, 12 (16.2%) did not start or discontinued treatment (4 reached LDL<100 mg/dl without PCSK9i administration, 3 had adverse events, 5 did not wish to start a subcutaneous treatment). Baseline LDL-c levels were 151±55mg/dl. In patients receiving PSCK9i, LDL-c levels after 3-6 months decreased to 64.8±34.8mg/dl, with a mean reduction of 79.6±42.4mg/dl (p<0.001).

Conclusion: Despite the body of evidence supporting the use of PCSK9i, different barriers make it difficult to incorporate this treatment to the therapeutic arsenal. An optimal and responsible selection of patients and a correct follow-up is needed in order to take advantage of these novel therapies.

Total patients (n=91)
Age, years (mean±SD) 62.1±11.3
Women, n (%) 43 (47.3)
Peripheral artery disease, n (%) 8 (8.8)
Coronary heart disease, n (%) 62 (68.1)
Cerebrovascular disease, n (%) 3 (3.3)
Familial hypercholesterolemia, n (%) 34 (37.4)
Statin intolerant, n (%) 30 (33)


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