A Clinical Pharmacist Patient-Safety Initiative to Reduce Against-Label Prescribing of Statins with Cyclosporine

Abstract

Study Funding: This study was supported by an independent educational grant from AstraZeneca. Background/Synopsis: Evidence-based guidelines were published in 2013 by the American College of Cardiology and American Heart Association (ACC/AHA) for treatment of dyslipidemia. The new guidelines have shifted from a ''treat to target lipid goals'' paradigm to focusing on reducing atherosclerotic cardiovascular disease (ASCVD) risk using an appropriate intensity of statin therapy. Physicians need expert guidance on incorporation of these guidelines into practice. Objective/Purpose: To determine if online educational interventions improve the evidence-based clinical decision making of primary care physicians (PCPs) and cardiologists in the U.S. related to the clinical application of new lipid management guidelines.Methods: An interactive, case-based, online CME activity was developed. The educational effects were assessed using a case-based linked pre-assessment/post-assessment study design that separated learners into three categories: improved (incorrect pre, correct post), reinforced (correct pre and post), and unaffected (incorrect pre and post). For all questions combined, the McNemar's chi-squared test was used to assess whether the mean post-assessment score differed from the mean pre-assessment score. P values are shown as a measure of significance; P values ,.05 are statistically significant. Cramer's V was used to calculate the effect size.Results: Improved clinical-decision making was seen among cardiologists (n 5 159; P ,.05; large effect size of 2.057) and PCPs (n 5 545; P ,.05; large effect size of 1.932). Correct responses on post-assessment questions were up to 309% and 288% higher after CME completion for cardiologists and PCPs, respectively. Learning concepts included understanding lipid management per the new guidelines, the percent reduction in LDL-C associated with high-intensity statin therapy, the frequency of 10year ASCVD risk score reassessment for primary prevention, and understanding lifestyle modifications to reduce LDL-C levels.Conclusions: This study demonstrates the success of a targeted, case-based, educational intervention on improving the clinical-decision making of US PCPs and cardiologists on the clinical application of updated lipid guidelines.

SLCO1B1*5 Allele Is Associated With Atorvastatin Discontinuation and Adverse Muscle Symptoms in the Context of Routine Care

“…Cyclosporine, a competitive inhibitor at the level of the organic anion transporter encoded by SLCO1B1 , is known to increase risk for SAMSs. Atorvastatin is a known substrate for this transporter, and coadministration of cyclosporine increases risk for atorvastatin‐induced myopathy 26–28 . We have recently shown that longitudinal data from EMRs can be used to validate this DDI as well as identify other concomitant medications previously unrecognized to increase risk for atorvastatin intolerance 28 .…”

“…Atorvastatin is a known substrate for this transporter, and coadministration of cyclosporine increases risk for atorvastatin-induced myopathy. [26][27][28] We have recently shown that longitudinal data from EMRs can be used to validate this DDI as well as identify other concomitant medications previously unrecognized to increase risk for atorvastatin intolerance. 28 Our current data demonstrate that a similar approach can be leveraged to confirm the clinical actionability of DGIs for statins as well.…”

Impact of educational outreach intervention on enhancing health care providers' knowledge about statin therapy prescribing in Malaysian patients with type 2 diabetes mellitus

“…Another recent study investigated the clinical pharmacist role to optimize statin treatment in patients taking cyclosporine. The results showed that switching patients to pravastatin or a low dose of rosuvastatin has been associated with better patient safety while not affecting overall LDL‐C reduction . The health care providers' knowledge about statins inter‐differences regarding their drug to drug interaction profiles is essential to maximizing the safety and efficacy of the given treatment.…”