Practical Considerations for the Use of Subcutaneous Treatment in the Management of Dyslipidaemia

Franck Boccara, Ricardo Dent, Luis Ruilope, Paul Valensi, Franck Boccara, Ricardo Dent, Luis Ruilope, Paul Valensi

Abstract

Suboptimal drug adherence represents a major challenge to effective primary and secondary prevention of cardiovascular disease. While adherence is influenced by multiple considerations, polypharmacy and dosing frequency appear to be rate-limiting factors in patient satisfaction and subsequent adherence. The cardiovascular and metabolic therapeutic areas have recently benefited from a number of advances in drug therapy, in particular protease proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and incretin-based therapies, respectively. These drugs are administered subcutaneously and offer efficacious treatment options with reduced dosing frequency. Whilst patients with diabetes and diabetologists are well initiated to injectable therapies, the cardiovascular therapeutic arena has traditionally been dominated by oral agents. It is therefore important to examine the practical aspects of treating patients with these new lipid-lowering agents, to ensure they are optimally deployed in everyday clinical practice.

Keywords: Adherence; Cardiovascular risk; Compliance; Evolocumab; Lipid-lowering; PCSK9; Self-administration; Statins; Subcutaneous.

Figures

Fig. 1
Fig. 1
Study design and recruitment for OSLER-2. Adapted from Koren et al., 2016 [132]. OL open-labelled, Q2W biweekly, QM monthly. Percentages reflect the proportion of patients continuing on dose frequency or changing to alternative dose frequency
Fig. 2
Fig. 2
Diagrams of a autoinjector, b prefilled syringe, and c automated minidoser (on-body infusor) [112]
Fig. 3
Fig. 3
THOMAS-1 and THOMAS-2 patient disposition. Taken from Dent et al. 2006 [112]

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Source: PubMed

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