(C-100) Prescribing Patterns and Lipid Control Outcomes of PCSK9 Inhibitors in the Greater Bay Area of China

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors blocks PCSK9 from breaking down low-density lipoprotein (LDL) receptors in the liver. This allows more LDL receptors to work, which reduces LDL cholesterol (LDL-C) levels in the blood. PCSK9 inhibitors (PCSK9i) have emerged as a breakthrough lipid-lowering therapy, enhancing the hepatic clearance of LDL-C. However, evidence regarding the utilisation of PCSK9i and its impact on lipid control in China remains limited.

Objectives: The study aims to describe the prescription trends and lipid control outcomes of PCSK9i in the Greater Bay Area (GBA), including Hong Kong, Shenzhen, Macao, and Guangzhou in China.

Methods: Data were extracted from five research centres in the GBA of China, including the Hong Kong Hospital Authority (HKHA), Hong Kong University - Shenzhen Hospital (HKUSZH), Macao University of Science and Technology Hospital (also known as University Hospital (MUST-UH) in Macao), Macao Health Bureau (SSM), and the First Affiliated Hospital of Jinan University in Guangzhou (JNUH). De-identified data on PCSK9i prescription and lipid test results were collected. PCSK9i was available starting from 2016 and later. The study period was defined as the time from the introduction of PCSK9i in the area or hospital up to Dec 2023. We described the prescribing trends of two PCSK9is (i.e., Alirocumab and Evolocumab) across all study centres, presenting the monthly number of new users of PCSK9i. LDL-C levels before and after PCSK9i initiation were analysed, and the percentage of patients achieving LDL-C reduction was calculated to assess lipid control.

Results: The total PCSK9i users identified were 2,143 in HKHA, 2,523 in HKUSZH, 87 in MUST-UH, 148 in SSM, and 3,076 in JNUH. The monthly number of new users prescribed PCSK9i ranged from 2 to 96 in HKHA, 3 to 160 in HKUSZH, 1 to 6 in MUST-UH, 1 to 7 in SSM, and 2 to 183 in JNUH, indicating an overall increasing trend in prescriptions. The prescriptions filled for each research centre were as follows: Evolocumab comprised 61.64% in HKHA, 37.65% in HKUSZH, 50.57% in MUST-UH, 18.92% in SSM, and 70.65% in JNUH; Alirocumab represented 38.36% in HKHA, 62.35% in HKUSZH, 44.83% in MUST-UH, 81.08% in SSM, and 29.35% in JNUH. Mean LDL-C levels among PCSK9i users decreased from 3.47 to 1.74 in HKHA, 2.92 to 1.72 in HKUSZH, 4.37 to 2.09 in MUST-UH, 3.15 to 1.69 in SSM, and 2.80 to 1.89 in JNUH. The percentages of people achieving an LDL-C reduction of ≥50% were 59.41% in HKHA, 49.63% in HKUSZH, 51.72% in MUST-UH, 60.98% in SSM, and 33.69% in JNUH.

Conclusions: This study bridges the evidence gap in real-world PCSK9i utilisation and LDL-C target achievement in the GBA in China and provides insights into region-specific challenges and opportunities for optimising lipid management strategies.