TY - JOUR
T1 - The patient journey with proprotein convertase subtilisin/kexin type 9 inhibitors in community practice
AU - Bradley, Corey K.
AU - Shrader, Peter
AU - Sanchez, Robert J.
AU - Peterson, Eric D
AU - Navar, Ann Marie
N1 - Funding Information:
Erin Campbell, MS, of the Duke Clinical Research Institute provided editorial assistance. This study was supported by Sanofi and Regeneron Pharmaceuticals, Inc., United States A.M.N. receives support from the NHLBI, United States (K01HL133416). Authors? contributions: A.M.N. and P.S. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. C.K.B. R.J.S. E.D.P. and A.M.N. were responsible for study concept and design. P.S. and A.M.N. were responsible for data analysis. C.K.B. R.J.S. E.D.P. and A.M.N. were responsible for interpretation of data. C.K.B. was responsible for drafting the article. C.K.B. R.J.S. E.D.P. and A.M.N. were responsible for critically revising the article.
Funding Information:
This study was supported by Sanofi and Regeneron Pharmaceuticals, Inc. , United States A.M.N. receives support from the NHLBI , United States ( K01HL133416 ).
Publisher Copyright:
© 2019 National Lipid Association
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Trials have demonstrated that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective as an adjunct to statin therapy, but access and cost issues have limited their use in community practice. Objective: The aim of the study was to better understand patients’ experiences when trying to obtain, fill, and use PCSK9 inhibitor therapy in community practice. Methods: We conducted a patient survey to evaluate patient experiences with PCSK9 inhibitors including medication initiation, indication for treatment, insurance approval status, medication persistence, and reason for discontinuation. The survey was emailed to 4740 adults who used a patient access support program. Results: Overall, 1327 of 4740 adults completed the survey (28.0% response rate). Of those, 75.0% were aged >60 years, 52.8% were male, and 92.4% were White. At the time of PCSK9 inhibitor prescription, 70.2% were not on a statin (with 84.4% of those not on a statin reporting statin intolerance). Overall, 74.6% of patients found the drug approval process to be “somewhat” or “very” burdensome. Among n = 1216 patients who initiated treatment, 33.7% discontinued by the time of the survey, with 50.0% taking the drug for 1 to 6 months. Patient out-of-pocket costs were the leading reported reason for discontinuation. Conclusions: Most PCSK9 inhibitor users in community practice were not on a statin, presumably because of statin intolerance. The drug approval process and costs continue to be strong reasons for lower initiation of PCSK9 agents, as well as higher discontinuation rates.
AB - Background: Trials have demonstrated that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective as an adjunct to statin therapy, but access and cost issues have limited their use in community practice. Objective: The aim of the study was to better understand patients’ experiences when trying to obtain, fill, and use PCSK9 inhibitor therapy in community practice. Methods: We conducted a patient survey to evaluate patient experiences with PCSK9 inhibitors including medication initiation, indication for treatment, insurance approval status, medication persistence, and reason for discontinuation. The survey was emailed to 4740 adults who used a patient access support program. Results: Overall, 1327 of 4740 adults completed the survey (28.0% response rate). Of those, 75.0% were aged >60 years, 52.8% were male, and 92.4% were White. At the time of PCSK9 inhibitor prescription, 70.2% were not on a statin (with 84.4% of those not on a statin reporting statin intolerance). Overall, 74.6% of patients found the drug approval process to be “somewhat” or “very” burdensome. Among n = 1216 patients who initiated treatment, 33.7% discontinued by the time of the survey, with 50.0% taking the drug for 1 to 6 months. Patient out-of-pocket costs were the leading reported reason for discontinuation. Conclusions: Most PCSK9 inhibitor users in community practice were not on a statin, presumably because of statin intolerance. The drug approval process and costs continue to be strong reasons for lower initiation of PCSK9 agents, as well as higher discontinuation rates.
KW - Cardiovascular disease
KW - PCSK9 inhibitor
KW - Prevention
KW - Proprotein convertase subtilisin/kexin type 9
KW - Utilization
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U2 - 10.1016/j.jacl.2019.06.008
DO - 10.1016/j.jacl.2019.06.008
M3 - Article
C2 - 31371271
AN - SCOPUS:85069862479
SN - 1933-2874
VL - 13
SP - 725
EP - 734
JO - Journal of Clinical Lipidology
JF - Journal of Clinical Lipidology
IS - 5
ER -