The benefits of lipid lowering therapy (LLT) include reductions in all-cause mortality and fatal CV disease. Studies have shown high rates of LLT discontinuation and poor persistence.
This study examined time to treatment modification and types of treatment modifications among patients initiating statin and ezetimibe therapy.
This retrospective claims-based study used medical, pharmacy and enrollment data from a large US health plan. Patients had commercial or Medicare Advantage Part D (MAPD) coverage from 1/1/07 to 12/31/12 and were followed for the earlier of 3 years, disenrollment or 12/31/13 (index date= date of first statin and/or ezetimibe use). Treatment modifications included switching, subtraction, dose escalation or reduction, augmentation, reduction, and discontinuation. Patients were assigned to one of three mutually exclusive cohorts: secondary CVD prevention, high risk primary prevention, and primary prevention. Arteriosclerotic cardiovascular disease (ASCVD) was also identified. The first episode of care was defined as the time from the index date to the first treatment modification (episode 1) and subsequent therapy modifications (episodes 2-4) were also examined.
The sample included 662,540 patients (mean age 57.4 years, 52.5% male, 19.2% MAPD). Overall mean time to first modification was 341.9 days (SD=333.7; median=200.0). Mean and medians were similar across cohorts but decreased with each subsequent episode of care. Discontinuation at 42.0% (with 70.5% restarting) was the most common treatment modification in the ASCVD cohort followed by switching (10.4%) and statin dose increase (10.3%). The other cohorts followed a similar pattern.
Patients remained on their index therapy for a substantial period of time. Surprisingly, there was little difference across risk groups. Initial choice of statin therapy by physician and patient may represent an opportunity to limit unnecessary statin and/or ezetimibe therapy modifications and to improve adherence.