RESUMO
BACKGROUND: This real-world study examined clinical characteristics and dyslipidemia management among patients initiating evolocumab across 12 European countries. Austrian data are reported. METHODS: Data of consenting adults were collected for ≤â¯6 months prior to evolocumab initiation (baseline) and ≤â¯30 months post-initiation. Patient characteristics, lipid lowering therapy (LLT, i.e. statin and/or ezetimibe) and lipid values were collected from medical records. RESULTS: In Austria, 363 patients were enrolled. At baseline, 52% of patients initiated evolocumab without background LLT; the median (Q1, Q3) initial low-density lipoprotein cholesterol (LDL-C) level was 142 (111, 187) mg/dL. Within 3 months of evolocumab treatment, median LDLC decreased by 59% to 58 (37, 91) mg/dL. This reduction was maintained over time, despite consistently infrequent use of background LLT. LDL-Câ¯< 55â¯mg/dL was attained by 65% of patients (76% with, 55% without background LLT). Evolocumab persistence was ≥â¯90% at month 12 and month 30. CONCLUSION: In Austria, patients were initiated on evolocumab at LDLC levels almost 3times higher than the guideline-recommended clinical goal (<â¯55â¯mg/dL). Persistence with evolocumab was very high. Evolocumab led to a rapid and sustained LDLC reduction with 65% attaining the LDLC goal. Patients using evolocumab in combination with statins and/or ezetimibe were more likely to attain their LDLC goal and thus decrease cardiovascular risk.
Assuntos
Anticorpos Monoclonais Humanizados , Anticolesterolemiantes , Inibidores de Hidroximetilglutaril-CoA Redutases , Adulto , Humanos , Anticorpos Monoclonais/uso terapêutico , Anticolesterolemiantes/uso terapêutico , Áustria/epidemiologia , LDL-Colesterol , Ezetimiba/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: The low-density lipoprotein cholesterol goals in the 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines necessitate greater use of combination therapies. We describe a real-world cohort of patients in Austria and simulate the addition of oral bempedoic acid and ezetimibe to estimate the proportion of patients reaching goals. METHODS: Patients at high or very high cardiovascular risk on lipid-lowering treatments (excluding proprotein convertase subtilisin/kexin type 9 inhibitors) from the Austrian cohort of the observational SANTORINI study were included using specific criteria. For patients not at their risk-based goals at baseline, addition of ezetimibe (if not already received) and subsequently bempedoic acid was simulated using a Monte Carlo simulation. RESULTS: A cohort of patients (Nâ¯= 144) with a mean low-density lipoprotein cholesterol of 76.4â¯mg/dL, with 94% (nâ¯= 135) on statins and 24% (nâ¯= 35) on ezetimibe monotherapy or in combination, were used in the simulation. Only 36% of patients were at goal (nâ¯= 52). Sequential simulation of ezetimibe (where applicable) and bempedoic acid increased the proportion of patients at goal to 69% (nâ¯= 100), with a decrease in the mean low-density lipoprotein cholesterol from 76.4â¯mg/dL at baseline to 57.7â¯mg/dL overall. CONCLUSIONS: The SANTORINI real-world data in Austria suggest that a proportion of high and very high-risk patients remain below the guideline-recommended low-density lipoprotein cholesterol goals. Optimising use of oral ezetimibe and bempedoic acid after statins in the lipid-lowering pathway could result in substantially more patients attaining low-density lipoprotein cholesterol goals, likely with additional health benefits.