Prescription Trends of Oral Non-Statin LLTs and Their Effects on LDL-C

Prescription Trends of Oral Non-Statin Lipid‑Lowering Therapies and Their Effects on Low-Density Lipoprotein-Cholesterol
 

• Statins are recommended by the ESC and EAS as first-line therapy for LDL-C reduction.
• However, in patients on statin monotherapy with substantially higher LDL-C levels than the recommended goals or with statin intolerance, poor management of LDL-C levels are observed, further substantiating a need for addition of a non-statin LLT such as ezetimibe to reduce LDL-C.
• Real-world data analyzed in this study provides trends in prescription of oral non-statin LLT that may further help identify opportunities to improve the low rates of LDL-C target attainment.

• Overall, 311,242 patients were included in the analyses.
  • BASELINE CHARACTERISTICS: Similar across patients
  • PREVALENCE OF ASCVD: Higher in patients prescribed ezetimibe (monotherapy or in combination with statins as FDC or in separate pills) and lower in patients prescribed fibrates vs statin monotherapy

PRESCRIPTION TRENDS IN LLTS

• STATIN MONOTHERAPY (GPs vs CARDIOLOGISTS): 91.6% vs 79%
• INCREASE IN PRESCRIPTION RATES (2013 to 2018):
  • Atorvastatin and rosuvastatin (patients treated by GPs vs cardiologists):
    • In 2013: 10.4% and 25.8%
    • In 2018: 34.7% and 58.3%
  • Simvastatin (patients treated by GPs vs cardiologists):
    • In 2013: 81.0% and 64.0%
    • In 2018: 60.0% and 37.0%
• NON-STATIN LLTs (2013-2018):
  • GPS:
    • In 2013: 4.6%
    • In 2018: 3.6
  • CARDIOLOGISTS:
    • In 2013: 7.2%
    • In 2018: 5.7%
  • No change in prescription rates for non-statin LLTs from 2013 to 2018.
  • Higher in patients treated by cardiologists vs GPs
• PRESCRIPTION OF EZETIMIBE:
  • Patients receiving ezetimibe in 2018 (patients treated by GPs vs cardiologists): 76.1% vs 92.8%
  • Steady increase over the study period
  • Prescribed with statin in majority of the cases

EFFECT OF STATIN/EZETIMIBE FDC OR SEPARATE PILLS ON LDL-C

• REDUCTION IN LDL-C BY ADDITION OF EZETIMIBE IN PATIENTS ON STATIN THERAPY
  • 23.8% (32.3 mg/dL)
  • Addition of ezetimibe in patients on statin, reduced LDL-C by an additional 23.8%.
• MEAN LDL-C REDUCTION WITH STATIN + EZETIMIBE
  • FDC: 28.4% (40.0 mg/dL) 
  • SEPARATE PILLS: 19.4% (27.5 mg/dL)
  • Reduction was considerably larger for FDC when statin and ezetimibe were prescribed in combination.
• PATIENTS REACHING LDL-C LEVEL OF <70 mg/dL WITH STATIN + EZETIMIBE
  • FDC vs SEPARATE PILLS): 31.5%
  • SEPARATE PILLS: 21.0%
  • Larger reduction of LDL-C resulted in better LDL-C control.

• Data not available on medication adherence that would strengthen study conclusion.
• Reasons for physicians prescribing FDC or separate pills could not be derived from the data, potentiating confounding related to the prescribing individuals.

* Between 2013 and 2018.
^† As per 2016 ESC/EAS guidelines.