Statin Prescribing in Patients With Non-Alcoholic Steatohepatitis in the United States: An Analysis of 3 Real-World Data Sources

OBJECTIVES: Dyslipidemia is one of the most common comorbidities (estimated prevalence: 60-70%) in non-alcoholic steatohepatitis (NASH). As a common comorbidity, patients with dyslipidemia NASH have an increased risk of cardiovascular events; thus, there may be high statin use in NASH patients. Given the paucity of evidence in the literature, the objective of this study was to examine real-world prescribing of statins in patients with NASH.

METHODS: We identified adults (≥18 years) with a diagnosis of NASH from three US data sources: Carelon Research (claims: 1/1/2022–31/12/2023), Veradigm (linked EHR and claims; 1/7/2018–31/8/2022), and nference (EHR: 1/1/1985–31/12/2023). We excluded patients with select alternative causes of fatty liver disease. For the Carelon and Veradigm analyses, we also required 2 years of continuous claims enrollment. In all three databases, we captured the use of atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin, dose, and days supply over 2 years.

RESULTS: Statin use among patients with NASH was 48.8% (9,285/19,036) in Carelon, 35.1% (35,721/101,800) in Veradigm, and 32.7% (3,005/9,186) in nference. Among statin users, 53.4%-58.9% used atorvastatin, 25.0%-35.1% used rosuvastatin, 9.1%-14.2% used pravastatin, 8.6%-11.3% used simvastatin, and less than 3% used lovastatin or fluvastatin. Across all adult NASH patients who met the selection criteria, few received the maximum recommended dose: 1.5%-2.5% received atorvastatin 80 mg, 0.2%-0.5% received pravastatin 80 mg, 0.7%-2.2% received rosuvastatin 40 mg, and 0.7%-1.6% received simvastatin 40 mg. Among the 4 most commonly used statins, median days’ supply over a two-year period ranged from 160–630 days.

CONCLUSIONS: Our study suggests that <50% of diagnosed NASH patients were on a statin (including high intensity), and few received the maximum dosage. Despite being the recommended first-line treatment for dyslipidemia in patients with NASH, clinicians may be hesitant to prescribe statins, and more so moderate-to-high intensity doses, in patients with liver dysfunction.