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Gargiulo P, Basile C, Cesaro A, Marzano F, Buonocore D, Asile G, Abbate V, Vicidomini F, Paolillo S, Spaccarotella CAM, Catalano A, Spirito G, Merlini PA, Maloberti A, Iannuzzo G, Ciccone MM, Zito AP, Paloscia L, D'Alleva A, Varbella F, Corleto A, Brunetti ND, Corbo MD, Calabrò P, Indolfi C, Perrone-Filardi P. Efficacy, safety, adherence and persistence of PCSK9 inhibitors in clinical practice: A single country, multicenter, observational study (AT-TARGET-IT). Atherosclerosis 2023; 366:32-39. [PMID: 36696749 DOI: 10.1016/j.atherosclerosis.2023.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/17/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
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.
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Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Davide Buonocore
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Gaetano Asile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Vincenza Abbate
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesca Vicidomini
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Angelo Catalano
- Cardiology Division Emergency Department, Roccadaspide Maria SS Addolorata General Hospital, Eboli, Italy
| | - Giulio Spirito
- Cardiology Division Emergency Department, Roccadaspide Maria SS Addolorata General Hospital, Eboli, Italy
| | | | - Alessandro Maloberti
- A. De Gasperis Cardio Center, ASST GOM Niguarda Ca' Granda, Milan, Italy; University of Milano-Bicocca, Milan, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Anna Paola Zito
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | | | | | | | | | - Maria Delia Corbo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ciro Indolfi
- Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy
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De Ferrari GM, Perna GP, Nicosia A, Guasti L, Casu G, Cuccia C, Picco F, Strazzella C, Totaro R, Cercone S, Canullo L, Horack M, Lautsch D, Gitt AK, Di Biase M. Available oral lipid-lowering agents could bring most high-risk patients to target: an estimate based on the Dyslipidemia International Study II-Italy. J Cardiovasc Med (Hagerstown) 2019; 19:485-490. [PMID: 29917002 DOI: 10.2459/jcm.0000000000000680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The analysis evaluated the contemporary percentage of patients with established coronary heart disease (CHD) reaching the European guidelines recommended LDL-cholesterol (LDL-C) levels of less than 70 mg/dl and the threshold required for proprotein convertase subtlisin/kexin type 9 reimbursement in Italy (100 mg/dl). It also assessed how these percentages would change in case of diffuse use of ezetimibe. METHODS The Dyslipidemia International Study II enrolled CHD patients aged at least 18 either on lipid-lowering therapy (LLT) for at least 3 months or not on LLT at the time of the lipid profile. Distribution of LLTs and LDL-C target attainment were assessed. Multivariate logistic regression evaluated predictors of LDL-C target attainment. A 24% LDL-C lowering was modeled in patients not taking ezetimibe to assess its potential effects. RESULTS Among 676 Italian CHD patients enrolled, LDL-C concentrations were lower among the 631 patients (93.3%) who were on LLT (82 versus 118 mg/dl; P < 0.001). The LDL-C target was attained by 35.4% of patients. Statin dose (median atorvastatin dose 40 mg/day) was the sole significant predictor of LDL-C target attainment. The simple addition of ezetimibe in the model reduced the percentage of patients more than 70 and 100 mg/dl from 64.6 to 37.9% and from 25.1 to 11.8%, respectively. CONCLUSION Despite treatment in more than 90%, only one-third of Italian stable CHD patients attained the recommended LDL-C target. Statin dose was the sole predictor of the target achievement. The addition of ezetimibe would almost double patients at target and halve the potential candidates for reimbursement of more expensive agents such as proprotein convertase subtlisin/kexin type 9 inhibitors.
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Affiliation(s)
- Gaetano M De Ferrari
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo.,Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia
| | - Gian P Perna
- Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona
| | | | - Luigina Guasti
- Centro di Ricerca delle Dislipidemie, Università dell'Insubria, Varese
| | | | | | | | - Caterina Strazzella
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo.,Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia
| | - Rossana Totaro
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo.,Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia
| | | | | | - Martin Horack
- Herzzentrum Ludwigshafen, Medizinische Klinik B.,Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - Anselm K Gitt
- Herzzentrum Ludwigshafen, Medizinische Klinik B.,Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Matteo Di Biase
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Foggia, Foggia, Italy
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3
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Colivicchi F, Sternhufvud C, Gandhi SK. Impact of treatment with rosuvastatin and atorvastatin on cardiovascular outcomes: evidence from the Archimedes-simulated clinical trials. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:555-65. [PMID: 26664148 PMCID: PMC4669037 DOI: 10.2147/ceor.s88817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective No clinical trials have been conducted to directly compare the effect of the two high-intensity statins, rosuvastatin and atorvastatin, on cardiovascular outcomes. However, three such trials have been computer-simulated using the Archimedes model, an individual-based simulation of human physiology and behaviors, treatment interventions, and health care systems. The results are reviewed here. Methods The first simulated trial assessed clinical outcomes in patients receiving available doses of the two drugs. The second assessed the impact of initial treatment decisions, while the third assessed the effect of switching from rosuvastatin to atorvastatin. Results In the first simulated trial, treatment with rosuvastatin was estimated to result in greater reductions than treatment with atorvastatin in major adverse cardiac event (MACE) rates at 5 years and 20 years at all doses examined (relative risk [RR]: 0.897, 0.888, and 0.930 at 5 years for rosuvastatin 20 mg vs atorvastatin 40 mg, rosuvastatin 40 mg vs atorvastatin 80 mg, and rosuvastatin 20 mg vs atorvastatin 80 mg, respectively; all P<0.05). In the second simulated trial, outcomes were significantly better in patients initially prescribed rosuvastatin than in those initially prescribed atorvastatin (RR of MACE at 5 years: 0.918; P<0.001). In the third simulated trial, risk of MACE was significantly greater in patients switching from rosuvastatin to atorvastatin than in those remaining on rosuvastatin (RR at 5 years: 1.109; P<0.001). Conclusion The results of these simulated clinical trials suggest improved outcomes among patients receiving rosuvastatin relative to patients receiving atorvastatin in various clinical settings.
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Affiliation(s)
- Furio Colivicchi
- Cardiology Division, Emergency Department, San Filippo Neri Hospital, ASL Roma E, Rome, Italy
| | | | - Sanjay K Gandhi
- Global Health Economics and Outcomes Research, TEVA Pharmaceuticals, Frazer, PA, United States
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Urbinati S, Olivari Z, Gonzini L, Savonitto S, Farina R, Del Pinto M, Valbusa A, Fantini G, Mazzoni A, Maggioni AP. Secondary prevention after acute myocardial infarction: Drug adherence, treatment goals, and predictors of health lifestyle habits. The BLITZ-4 Registry. Eur J Prev Cardiol 2014; 22:1548-56. [DOI: 10.1177/2047487314561876] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/08/2014] [Indexed: 11/15/2022]
Affiliation(s)
| | - Zoran Olivari
- Ospedale Ca’ Foncello, Department of Cardiology, Treviso, Italy
| | | | | | - Rosario Farina
- A.O.U. S. Giovanni di Dio – Ruggi D’Aragona, UOC UTIC, Salerno, Italy
| | - Maurizio Del Pinto
- Azienda Ospedaliera di Perugia, Department of Cardiology, Perugia, Italy
| | - Alberto Valbusa
- IRCCS Az Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Department of Cardiology, Genova, Italy
| | - Giuseppe Fantini
- Azienda Ospedaliero-Universitaria Policlinico, Department for the Treatment of Cardiovascular Diseases, Modena, Italy
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Deales A, Fratini M, Romano S, Rappelli A, Penco M, Perna GP, Beccaceci G, Borgia R, Palumbo W, Magi M, Vespasiani G, Bronzini M, Musilli A, Nocciolini M, Mezzetti A, Manzoli L. Care manager to control cardiovascular risk factors in primary care: the Raffaello cluster randomized trial. Nutr Metab Cardiovasc Dis 2014; 24:563-571. [PMID: 24472633 DOI: 10.1016/j.numecd.2013.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/31/2013] [Accepted: 11/24/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIM This cluster randomized trial evaluated the efficacy of a disease and care management (D&CM) model in cardiovascular (CVD) prevention in primary care. METHODS AND RESULTS Eligible subjects had ≥ 1 among: blood pressure ≥ 140/90 mmHg; glycated hemoglobin ≥ 7%; LDL-cholesterol ≥ 160 or ≥ 100 mg/dL (primary or secondary prevention, respectively); BMI ≥ 30; current smoking. The D&CM intervention included a teamwork including nurses as care managers for the implementation of tailored care plans. Control group was allocated to usual-care. The main outcome was the proportion of subjects achieving recommended clinical targets for ≥ 1 of uncontrolled CVD risk factors at 12-month. During 2008-2009 we enrolled 920 subjects in the Abruzzo/Marche regions, Italy. Following the exclusion of L'Aquila due to 2009 earthquake, final analyses included 762 subjects. The primary outcome was achieved by 39.1% (95%CI: 34.2-44.2) and 25.2% (95%CI: 20.9-29.9) of subjects in the intervention and usual-care group, respectively (p < 0.001). The D&CM intervention significantly increased the proportion of subjects who achieved clinical targets for both diabetes and hypertension, with no differences in hypercholesterolemia, smoking status and obesity. CONCLUSIONS The D&CM intervention was effective in controlling cardiovascular risk factors, in particular hypertension and diabetes. Numbers needed to treat were small. Such intervention may deserve further consideration in clinical practice. REGISTRATION NUMBER ACTRN12611000813987.
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Affiliation(s)
- A Deales
- Clinical Governance Area, Regional Healthcare Agency of Marche Region, Ancona, Italy
| | - M Fratini
- Clinical Governance Area, Regional Healthcare Agency of Marche Region, Ancona, Italy
| | - S Romano
- Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
| | - A Rappelli
- Polytechnic University of Marche, Ancona, Italy
| | - M Penco
- Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy
| | - G Piero Perna
- Department of Cardiovascular Diseases, University Hospital Umberto I, Ancona, Italy
| | | | - R Borgia
- Health District of Francavilla, Chieti, Italy
| | - W Palumbo
- Primary Care Practice of L'Aquila, Italy
| | - M Magi
- Primary Care Practice of Ancona, Italy
| | - G Vespasiani
- Diabetes Care Center Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - M Bronzini
- Polytechnic University of Marche, Ancona, Italy
| | - A Musilli
- Alliance Development & Health Solutions Manager, Pfizer, Italy
| | - M Nocciolini
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti, Italy
| | - A Mezzetti
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti, Italy; Clinical Research Center, Ce.S.I., University "G. d'Annunzio" Foundation, Chieti, Italy
| | - L Manzoli
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti, Italy.
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