June 03, 2021
The PCSK9 inhibitor evolocumab (Repatha; Amgen) cut LDL-cholesterol levels by more than 50% in patients at very high risk of cardiovascular events in the HEYMANS observational study, but almost half weren’t on a statin or ezetimibe, likely because they were intolerant to the drugs.
In this real-world analysis of patients with heterozygous FH (HeFH), only one-third were prescribed a high-intensity statin with ezetimibe while 44.5% weren’t prescribed any statin at all.
Kausik Ray, MD (Imperial College London, England), who led the HEYMANS study, told TCTMD there is an LDL threshold for financial reimbursement that ranges from 140 to 160 mg/dL among the different European countries, meaning that only patients with high baseline LDL-cholesterol levels are being prescribed the monoclonal antibodies. As a result, the most likely way these patients qualify for the drug is if they are statin intolerant.