REAL-WORLD PRESCRIPTION PATTERNS, ADHERENCE, AND LDL REDUCTION OF PCSK9 INHIBITOR USERS IN CHINA: EVIDENCE FOLLOWING NRDL INCLUSION
Author(s)
Siqi Ni, MSc Candidate1, Xiaoning He, PhD1, Jun Zhang, MSPH, MD2, Larry Z. Liu, PhD, MD3, yanbing zhou, PhD3, Jing Wu, PhD1.
1Tianjin University, Tianjin, China, 2MSD R&D (China) Co., Ltd., Beijing, China, 3Merck & Co., Inc., Rahway, NJ, USA.
1Tianjin University, Tianjin, China, 2MSD R&D (China) Co., Ltd., Beijing, China, 3Merck & Co., Inc., Rahway, NJ, USA.
OBJECTIVES: PCSK9 inhibitors (PCSK9i), for treating elevated LDL-C, have been introduced into clinical practice following their inclusion in China’s National Reimbursement Drug List (NRDL) in 2022. This study aimed to evaluate prescription patterns, adherence and persistence, and examine LDL-C reduction among treated patients.
METHODS: Retrospective observational cohort data were obtained from the hospital information system of over 70 secondary and tertiary hospitals in Tianjin. Adult patients initiating injectable PCSK9i (alirocumab or evolocumab) between January and December 2022 were identified, with a maximum follow-up until June 2023. Baseline characteristics were assessed during 1 year before the first PCSK9i prescription (index date). Prescription patterns, adherence, persistence, and longitudinal LDL-C changes were analyzed using standardized definitions. Adherence was measured by the proportion of days covered (PDC), and persistence as continuous use without discontinuation. Descriptive statistics summarized all variables.
RESULTS: A total of 10,571 patients (mean age 61.9 years, 59.2% male) initiating PCSK9i were included. Before treatment, 67.9% used statin monotherapy and 4.4% statin plus ezetimibe. Within a median follow-up of 11.7 months (IQR 6.8 months), 49.7% of patients received only one PCSK9i prescription (mean 2.54 prescriptions). The mean PDC was 0.30, with 75.5% of patients discontinuing therapy. PCSK9i therapy was associated with a mean LDL-C reduction of approximately 35%, with 48.6% and 31.3% of patients achieving LDL-C levels below 1.8 and 1.4 mmol/L, respectively. Patients with higher adherence demonstrated greater and more sustained LDL-C reduction over time.
CONCLUSIONS: In this real-world analysis, injectable PCSK9i therapy effectively improved LDL-C control in the short term, particularly among patients with higher adherence. However, the overall adherence and persistence with PCSK9i therapy were substantially low in China, which may have limited the magnitude of LDL-C reduction. Future efforts should focus on enhancing long-term adherence to maximize the clinical benefits of PCSK9 inhibitors.
METHODS: Retrospective observational cohort data were obtained from the hospital information system of over 70 secondary and tertiary hospitals in Tianjin. Adult patients initiating injectable PCSK9i (alirocumab or evolocumab) between January and December 2022 were identified, with a maximum follow-up until June 2023. Baseline characteristics were assessed during 1 year before the first PCSK9i prescription (index date). Prescription patterns, adherence, persistence, and longitudinal LDL-C changes were analyzed using standardized definitions. Adherence was measured by the proportion of days covered (PDC), and persistence as continuous use without discontinuation. Descriptive statistics summarized all variables.
RESULTS: A total of 10,571 patients (mean age 61.9 years, 59.2% male) initiating PCSK9i were included. Before treatment, 67.9% used statin monotherapy and 4.4% statin plus ezetimibe. Within a median follow-up of 11.7 months (IQR 6.8 months), 49.7% of patients received only one PCSK9i prescription (mean 2.54 prescriptions). The mean PDC was 0.30, with 75.5% of patients discontinuing therapy. PCSK9i therapy was associated with a mean LDL-C reduction of approximately 35%, with 48.6% and 31.3% of patients achieving LDL-C levels below 1.8 and 1.4 mmol/L, respectively. Patients with higher adherence demonstrated greater and more sustained LDL-C reduction over time.
CONCLUSIONS: In this real-world analysis, injectable PCSK9i therapy effectively improved LDL-C control in the short term, particularly among patients with higher adherence. However, the overall adherence and persistence with PCSK9i therapy were substantially low in China, which may have limited the magnitude of LDL-C reduction. Future efforts should focus on enhancing long-term adherence to maximize the clinical benefits of PCSK9 inhibitors.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD38
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)