OBJECTIVES: To assess treatment patterns of statin and/or ezetimibe and possible statin intolerance among patients with clinical ASCVD or DM in Taiwan.

METHODS: We conducted a retrospective cohort study using Taiwan’s 2005-2013 National Health Insurance Research Database (NHIRD). Patients with history of clinical ASCVD or DM (without previous clinical ASCVD) and newly initiating stain or statin plus ezetimibe during 2006 to 2012 were identified. The treatment initiation date was defined as index date. Treatment patterns (including discontinuation, re-initiation, subtraction, switching and augmentation), adherence (medication possession ratio, MPR) and persistence (gap no greater than 60 days) of statin and/or ezetimibe during 12-month post-index period were examined. Possible statin intolerance as per previously developed algorithm was estimated. All the analyses were conducted among clinical ASCVD cohort and DM cohort.

RESULTS: Among patients initiating stain or statin plus ezetimibe, 11,092 patients with history of clinical ASCVD and 31,100 patients with DM but without clinical ASCVD were analyzed. The discontinuation, re-initiation and switching rates among patients with clinical ASCVD were 54.0%, 11.3% and 25.7% during the follow-up period, respectively. Among patients with DM, the rates were 57.5%, 14.2% and 28.5%. Only less than 1% patients of the overall study cohort encountered subtraction or augmentation. The MPR of statins among clinical ASCVD and DM cohort were 0.62 and 0.60, respectively. Persistence to statin treatment among ASCVD was 46.1% and among DM patients was 42.6%. Among ASCVD and DM patients possible statin intolerance was observed among 19.9% and 21.4% of patients, respectively.

CONCLUSIONS: This national database analysis indicates that more than half of patients with clinical ASCVD or DM discontinued statin and/or ezetimibe within 12-month period and the adherence and persistence of statin therapy were suboptimal indicating unmet need of lipid control treatment.