Patients with high cardiovascular risk as candidates to bempedoic acid after treatment with statins, ezetimibe and PCSK9 inhibitors. An estimation and cost-effectiveness analysis.

以兹提米比 医学 PCSK9 低密度脂蛋白胆固醇 估计 内科学 胆固醇 药理学 低密度脂蛋白受体 脂蛋白 经济 管理
作者
José Seijas‐Amigo,Alberto Cordero,Rosa Fernández Olmo,Gustavo A. Cortez Quiroga,Lorenzo Fácila,Ángel Salgado‐Barreira,Francisco Reyes-Santías,César Romero‐Menor,Juan Rondán,Moisés Rodríguez‐Mañero,M C Bello Mora,Alfonso Valle,Miriam Sandín,Román Freixa‐Pamias,Jordi Bañeras,Pedro Blanch García,Milagros Clemente Lorenzo,Sergio Sánchez‐Álvarez,Luis López‐Rodríguez,José Ramón González‐Juanatey
出处
期刊:Journal of Cardiovascular Pharmacology [Lippincott Williams & Wilkins]
卷期号:81 (1): 70-75 被引量:5
标识
DOI:10.1097/fjc.0000000000001365
摘要

Abstract: Low-density lipoprotein cholesterol (LDLc) is the lead effector of atherosclerosis and main treatment target. Bempedoic acid is a novel oral drug in the therapeutic armamentarium which is able to reduce LDLc. The objectives of this study were (1) to select the potential patients for administering bempedoic acid such as those with a very high cardiovascular risk in which objectives of LDLc were not achieved despite conventional treatment with PCSK9 inhibitors (PCSK9i) and/or statins and ezetimibe and (2) to estimate the cost-effectiveness of bempedoic acid in different scenarios. The methods used were a multicenter and retrospective study of 652 patients initiating treatment with any PCSK9 inhibitor in 17 different hospitals. Before and on-treatment LDLc cholesterol levels, medical treatments, clinical indication, and baseline characteristics were recorded. The results obtained from 443 subjects in secondary prevention were analyzed. The mean (±) LDLc level at baseline was 142.5 ± 46.4 mg/dL and 61.5 ± 40.5 mg/dL in the follow-up, with a reduction of 55.9% ( P < 0.0001); 71.6% of the patients reached the target of LDL < 55 mg/dL or >50% reduction. Of those patients treated with medium-intensity and low-intensity statins plus PCSK9 inhibitors (with or without ezetimibe), only 5.7% of them were able to reduce LDL below 55 mg/dL and the main LDLc reduction in this group was the lowest (42.9% on average). Patients with TG values >135 mg/dL represented 41.6% of the sample, of which approximately 10% of them were using fibrates. Assuming only LDLc reduction and the UK price, the incremental cost-effectiveness ratio was 88,359€; 83,117€; 82,378€; and 79,015€ for different discount rates. In conclusion, one-third of the patients could achieve the target LDL proposed in the 2019 ESC/EAS guidelines. Approximately 10% of them could also benefit from treating hypertriglyceridemia as indicated in the 2021 ESC guidelines on cardiovascular disease prevention. Patients with medium-intensity and low-intensity statins plus PCSK9i and ezetimibe would be the most benefited. Bempedoic acid could be a not cost-efficacy therapy in all the scenarios, but we need to wait for the CLEAR OUTCOMES Trial results.
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