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Dyslipidemia KOL Insight Interview #1

July 25, 2014

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KOL Highlights

    Dyslipidemia, PCSK9 and CETP Inhibitors

  • Cardiologists in KOL's large group sticking to old cholesterol guidelines and goals.
  • Statin intolerant: about ~5% of his cardiology patients, with 30-40% able to still reach the 100 mg/dl goal but hardly any a 70 mg/dl goal.
  • Statin tolerant: 90% can reach 100 mg/dl goal and about 70% the 70 mg/dl goal. If patients are in the 80's, close enough.
  • Prior to outcomes studies, would recommend PCSK9 inhibitors in most patients with LDL-c over 180 mg/dl, a minority with LDL-c 110 mg/dl or lower, and 50-60% of those in between. 70-80% would accept the recommendations and be compliant.
    • Believes in LDL-c hypothesis, but still wary about drugs without outcomes trials.
  • Discusses usage of PCSK9 and CETP inhibitors in various scenarios based on outcomes data (see table in full report for summary). In addition:
    • Diabetics and some others may still prefer injection if outcomes benefits similar.
    • If patients take CETP inhibitors and still do not reach old LDL-c goals, would not add PCSK9 inhibitor.
    • If CETP inhibitors only effective in those with low HDL-c, impacts ~30% of patients.
  • Prior to information on patient discomfort, thinks alirocumab (REGN, SNY) two injections/month will be preferred over biweekly injections or evolocumab (AMGN) monthly mini-doser.
  • Copays need to be less than $100 in his lower to middle income population. If one class has $50 copay and another $100, only expects modest impact on patient preferences.
  • Not very concerned about potential cognitive side effects with PCSK9 inhibitors.
    • Cardiovascular Disease, Zontivity
  • Most with an MI get a drug-eluting stent with P2Y12 anti-platelet agents for a year.
  • Less than 5% are recommended to stay on them longer, and it is quite rare particularly for Effient or Ticagrelor.
  • Would use in most of post-MI patient, but according to how it was studied: in those with an MI 2 weeks to 12 months in the past.
  • About 20% at high risk for bleeding—would not use in those. Otherwise, bleeding risk does not look too bad if not post-stroke or ACS patient.
Please see our pulse survey for additional physician opinion on Zontivity. To purchase the full Dyslipidemia KOL Insight Interview, click the link at the top of the page.
For our disclosures, please read the BioMedTracker Research Standards.
Disease Group Covered: Cardiovascular

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