Highlights
- •PCSK9i have been proven to reduce cardiovascular events in hypercholesterolemia patients.
- •Few studies are available in a real-world setting on the use and effects of PCSK9i.
- •AT-TARGET-IT is the first Italian nation-wide registry on PCSK9i.
- •PCSK9i were very effective, leading to high adherence and persistence to therapy.
- •LDL-C target was reached in most patients, especially when used in combined therapy.
Abstract
Background and aims
Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (PCSK9i) are recommended
in patients at high and very-high cardiovascular (CV) risk, with documented atherosclerotic
CV disease (ASCVD), and for very-high risk patients with familial hypercholesterolaemia
not achieving LDL-cholesterol (LDL-C) goal while receiving maximally tolerated dose
of lipid-lowering therapy (LLT). However, single country real-life data, reporting
the use of PCSK9i in clinical practice, are limited. Therefore, we designed AT-TARGET-IT,
an Italian, multicenter, observational registry on the use of PCSK9i in clinical practice.
Methods
All data were recorded at the time of the first prescription and at the latest observation
preceding inclusion in the study.
Results
798 patients were enrolled. The median reduction in LDL-C levels was 64.9%. After
stratification for CV risk, 63.8% achieved LDL-C target; of them, 83.3% took LLTs
at PCSK9i initiation and 16.7% did not. 760 patients (95.2%) showed high adherence
to therapy, 13 (1.6%) partial adherence, and 25 (3.1%) poor adherence. At 6 months,
99.7% of patients enrolled in the study remained on therapy; there were 519 and 423
patients in the study with a follow-up of at least 12 and 18 months, respectively.
Persistence in these groups was 98.1% and 97.5%, respectively. Overall, 3.5% of patients
discontinued therapy. No differences in efficacy, adherence, and persistence were
found between alirocumab and evolocumab.
Conclusions
PCSK9i are safe and effective in clinical practice, leading to very high adherence
and persistence to therapy, and achievement of recommended LDL-C target in most patients,
especially when used as combination therapy.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: January 11, 2023
Accepted:
January 10,
2023
Received in revised form:
December 17,
2022
Received:
November 12,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
