Real-world Evidence for Adherence and Persistence with Atorvastatin Therapy

Tsioufis, Κonstantinos; Castellano, José M.; Sykara, Georgia; Malvestiti, Franco Mondello; Vugt, Joris van

doi:10.1007/s40119-021-00240-8

Cited by 10 publications

(15 citation statements)

References 103 publications

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“…However, it is more likely due to changes in background lipid-lowering therapy than variance in evolocumab efficacy over time. Nonadherence to lipid-lowering therapy is widely reported and has a significant impact on treatment success [31][32][33]. Clinical evidence supports the consistency of evolocumab's lipid-lowering effect, as comparable reductions in LDL-C levels with evolocumab use were observed across racial/ethnic groups in both short-term (12 weeks) and long-term (1-5 years) studies [34].…”

Section: Plos Onementioning

confidence: 90%

Multizonal observational study conducted by clinical practitioners on evolocumab use in subjects with hyperlipidemia in Saudi Arabia and Kuwait: Results from the ZERBINI study

et al. 2023

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Objectives Dyslipidemia is a prevalent condition with significant morbidity and mortality across the world, including in the Arabian Gulf. The present study aimed to describe the characteristics of patients receiving evolocumab in clinical practice. Methods ZERBINI was a multi-country, observational, retrospective/prospective study of subjects receiving evolocumab as part of routine clinical management of their hyperlipidemia. This regional publication reports on adult participants from Saudi Arabia and Kuwait who have had ≥1 dose of evolocumab before enrollment and ≤6 months’ prior exposure to evolocumab. Patient characteristics and treatment persistence data were collected in addition to baseline and follow-up data up to 12 months post-evolocumab initiation. Results Overall, 225 patients were included from two sites, Saudi Arabia (N = 155) and Kuwait (N = 70). Mean age was comparable across sites and most patients had baseline coronary artery disease and/or hypertension. Baseline LDL-C levels (mean ± SD 3.6 ± 1.4 mmol/L in Saudi Arabia, 3.1 ± 1.4 mmol/L in Kuwait) were reduced by approximately 57%–62% in the first 6 months after evolocumab initiation (1.5 ± 1.2 mmol/L in Saudi Arabia [n = 63], 1.2 ± 0.8 mmol/L in Kuwait [n = 28]). This decrease was maintained over the 12-month follow-up period. Most patients achieved ACC 2018 LDL-C goals (<1.8 mmol/L; 74.6% in Saudi Arabia, 93.1% in Kuwait) and ESC 2019 LDL-C goals (<1.4 mmol/L; 66.7% in Saudi Arabia, 75.9% in Kuwait) in the first 6 months after evolocumab initiation. Medication persistence with evolocumab was high (up to 90.7%). Evolocumab had a favorable safety profile and no treatment-emergent adverse events were observed at either site. Conclusion Evolocumab is an effective lipid-lowering treatment in local populations. LDL-C goal achievement is increased when evolocumab is added to background lipid-lowering therapy with high tolerability and persistence. Long-term follow-up and large-scale data are needed to further support these observations.

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Section: Plos Onementioning

confidence: 90%

Multizonal observational study conducted by clinical practitioners on evolocumab use in subjects with hyperlipidemia in Saudi Arabia and Kuwait: Results from the ZERBINI study

et al. 2023

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“…[14] Of note, a long-term high dose of atorvastatin administration could lead to a reduced rate in compliance. [15] Therefore, adequate atorvastatin treatment can reduce the chance of liver damage by bringing the lipid level up to standard as soon as possible, since the low dose of atorvastatin can be maintained for a long time. It is well known that the efficacy of statins depends on many factors [15] ; however, few predictive studies have been reported on the efficacy of statins administered for a 1-month course of treatment for lipid reduction in individuals.…”

Section: The Authors Have No Conflicts Of Interest To Disclosementioning

confidence: 99%

“…[15] Therefore, adequate atorvastatin treatment can reduce the chance of liver damage by bringing the lipid level up to standard as soon as possible, since the low dose of atorvastatin can be maintained for a long time. It is well known that the efficacy of statins depends on many factors [15] ; however, few predictive studies have been reported on the efficacy of statins administered for a 1-month course of treatment for lipid reduction in individuals. Our study was to predict, using supervised machine-learning, the lipid-lowering effect of atorvastatin in the 1-month course of treatment in individuals.…”

Section: Introductionmentioning

confidence: 99%

Machine-learning-based analysis of the sensitivity and specificity on lipid-lowering effect of one-month-administered statins

et al. 2023

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Few predictive studies have been reported on the efficacy of atorvastatin in reducing lipoprotein cholesterol to be qualified after 1-month course of treatment in different individuals. A total of 14,180 community-based residents aged ≥ 65 received health checkup, 1013 of whom had low-density lipoprotein (LDL) higher than 2.6mmol/L so that they were put on 1-month course of treatment with atorvastatin. At its completion, lipoprotein cholesterol was measured again. With < 2.6 mmol/L considered as the treatment standard, 411 individuals were judged as the qualified group, and 602, and as the unqualified group. The basic sociodemographic features covered 57 items. The data were randomly divided into train sets and test ones. The recursive random-forest algorithm was applied to predicting the patients response to atorvastatin, the recursive feature elimination method, to screening all the physical indicators. The overall accuracy, sensitivity and specificity were calculated, respectively, and so were the receiver operator characteristic curve and the area under the curve of the test set. In the prediction model on the efficacy of 1-month treatment of statins for LDL, the sensitivity, 86.86%; and the specificity, 94.83%. In the prediction model on the efficacy of the same treatment for triglyceride, the sensitivity, 71.21%; and the specificity, 73.46%. As to the prediction of total cholesterol, the sensitivity, 94.38%; and the specificity, 96.55%. And in the case of high-density lipoprotein (HDL), the sensitivity, 84.86%; and the specificity, 100%. recursive feature elimination analysis showed that total cholesterol was the most important feature of atorvastatin efficacy of reducing LDL; that HDL was the most important one of its efficacies of reducing triglycerides; that LDL was the most important one of its efficacies of reducing total cholesterol; and that triglyceride was the most important one of its efficacies of reducing HDL. Random-forest can help predict whether atorvastatin efficacy of reducing lipoprotein cholesterol to be qualified after 1-month course of treatment in different individuals.

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“…A recent study using the Estonian Myocardial Infarction Registry, which included more than 6,000 MI cases per period, has shown that statin prescription had raised from 44% in the period 2004-2005 to 67% in the period 2017-2018 (91). Although the efficacy of atorvastatin has been demonstrated in several RCTs and metaanalyses, LDL-C goal achievement remains inadequate in a realworld setting (92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105).…”

Section: Overtreatment and Undertreatment In Lipid-lowering Therapies...mentioning

confidence: 99%

Undertreatment or Overtreatment With Statins: Where Are We?

García-Fernández-Bravo

Torres-Do-Rego

López‐Farré

et al. 2022

Front. Cardiovasc. Med.

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Statins, in addition to healthy lifestyle interventions, are the cornerstone of lipid-lowering therapy. Other low-density lipoprotein (LDL)-lowering drugs include ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. As new evidence emerges from new clinical trials, therapeutic goals change, leading to renewed clinical guidelines. Nowadays, LDL goals are getting lower, leading to the “lower is better” paradigm in LDL-cholesterol (LDL-C) management. Several observational studies have shown that LDL-C control in real life is suboptimal in both primary and secondary preventions. It is critical to enhance the adherence to guideline recommendations through shared decision-making between clinicians and patients, with patient engagement in selecting interventions based on individual values, preferences, and associated conditions and comorbidities. This narrative review summarizes the evidence regarding the benefits of lipid-lowering drugs in reducing cardiovascular events, the pleiotropic effect of statins, real-world data on overtreatment and undertreatment of lipid-lowering therapies, and the changing LDL-C in targets in the clinical guidelines of dyslipidemias over the years.

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Real-world Evidence for Adherence and Persistence with Atorvastatin Therapy

Cited by 10 publications

References 103 publications

Multizonal observational study conducted by clinical practitioners on evolocumab use in subjects with hyperlipidemia in Saudi Arabia and Kuwait: Results from the ZERBINI study

Multizonal observational study conducted by clinical practitioners on evolocumab use in subjects with hyperlipidemia in Saudi Arabia and Kuwait: Results from the ZERBINI study

Machine-learning-based analysis of the sensitivity and specificity on lipid-lowering effect of one-month-administered statins

Undertreatment or Overtreatment With Statins: Where Are We?

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