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. 2024 Aug;41(8):3407-3418.
doi: 10.1007/s12325-024-02916-8. Epub 2024 Jul 4.

Differential Adherence to Free and Single-Pill Combination of Rosuvastatin/Ezetimibe: Findings from a Real-World Analysis in Italy

Leopoldo Perez de Isla  1 , Evangelos Liberopoulos  2 , Melania Dovizio  3 , Chiara Veronesi  3 , Luca Degli Esposti  3 , Alberto Zambon  4
Affiliations

Differential Adherence to Free and Single-Pill Combination of Rosuvastatin/Ezetimibe: Findings from a Real-World Analysis in Italy

Leopoldo Perez de Isla et al. Adv Ther. 2024 Aug.

Abstract

Introduction: Adherence to cardiovascular drug treatment can significantly benefit from a reduced pill burden, but data on this matter derived from real-life settings are currently scanty. This analysis assessed the possible changes in adherence in patients treated with rosuvastatin and ezetimibe (ROS/EZE) as free multi-pill combination who switched to ROS/EZE as single-pill combination in the setting of real clinical practice in Italy.

Methods: A retrospective analysis was conducted on the administrative databases for a catchment area of about seven million health-assisted residents. Adults receiving ROS/EZE as a single-pill combination from January 2010 to June 2020 (followed up to 2021) were identified. The date of the first prescription of single-pill combination of ROS/EZE was considered as the index date. The analysis included the users of ROS/EZE as a free combination during the year before the index date. Baseline demographic and clinical characteristics were collected during the period of data availability prior to the index date. Adherence to therapy was evaluated as proportion of days covered (PDC), namely the percentage of days during which a patient had access to medication, in the 12-month interval preceding or following the index date (PDC < 25% non-adherence; PDC = 25-75% partial adherence; PDC > 75% adherence).

Results: A total of 1219 patients (61.1% male, aged 66.2 ± 10.4 years) were included. Cardiovascular comorbidities were found in 83.3% of them, diabetes in 26.4%, and a combination of both in 16.2%. Single-pill combination of ROS/EZE was associated with a higher proportion of adherent patients compared to free-pill combination (75.2% vs 51.8%, p < 0.001).

Conclusions: This real-world analysis suggested that switching from a regimen based on separate pills to one based on a single-pill combination resulted in improved adherence to ROS/EZE therapy.

Keywords: Adherence; Ezetimibe; Rosuvastatin; Single-pill combination.

Plain language summary

Lipid-lowering therapy to control low-density lipoprotein (LDL) cholesterol levels is essential for cardiovascular risk prevention. Successful therapy depends on the type of lipid-lowering therapy, i.e., low or high statin intensity and combination of statins with ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and adherence to therapy, i.e., whether the patient actually takes their pills as prescribed. If there are fewer pills to be taken, this can help patients to follow their treatment. Single-pill combinations of two drugs could facilitate adherence and thus the chances of reaching the recommended lipid targets. Here, we analyzed a sample of Italian patients with dyslipidemia to examine whether the switch from a free combination of two separate pills of rosuvastatin and ezetimibe to a single-pill combination of the same drugs could improve adherence to therapy. We found that the proportion of adherent patients increased from about just over half (51.8%) to about three-fourths (75.1%) when switching from two-pill to single-pill combination of rosuvastatin and ezetimibe. These findings suggest that simplifying therapy can help improve patient adherence, which is essential for reaching lipid targets and ultimately for alleviating atherosclerotic cardiovascular disease.

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Conflict of interest statement

Leopoldo Perez de Isla reports research grants, speaker fees and consultant fees from Servier, Sanofi, Amgen, Daiichi-Sankyo and Merk. Evangelos Liberopoulos reports grants from Hellenic Atherosclerosis Society; personal fees and non-financial support from Amgen, personal fees from Sanofi, personal fees from Lilly, personal fees from Bayer, personal fees from Novo Nordisk, grants and personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Servier, grants and personal fees from Viatris, outside the submitted work. Alberto Zambon reports speaker fees and consultant fees from Amgen, Amarin, Amryt, AlfaSigma, Abbott, Viatris, Novartis, Sanofi, Sobi, Servier, Daiichi Sankyo. Melania Dovizio, Chiara Veronesi, Luca Degli Esposti have no competing interests to disclose.

Figures

Fig. 1
Fig. 1
Scheme for the evaluation of drug utilization. ROS/EZE rosuvastatin and ezetimibe
Fig. 2
Fig. 2
Combinations of comorbidities and co-medications of patients starting ROS/EZE as a single-pill between January 2010 and June 2020. Cardiovascular comorbidities identified by the presence of cardiovascular hospitalization (ischemic heart, heart failure, cerebrovascular disease, peripheral vascular disease); cardiovascular drugs (other antihypertensive treatment, lipid-lowering treatment). Other comorbidities identified by the presence of anti-inflammatory treatments, psychiatric conditions (hospitalization/drugs), CKD, COPD. CKD chronic kidney disease, COPD chronic pulmonary disease, ROS/EZE rosuvastatin and ezetimibe
Fig. 3
Fig. 3
Proportion of patients by level of adherence, before and after the switch to ROS/EZE single-pill combination. PDC proportion of days covered, ROS/EZE rosuvastatin and ezetimibe
See this image and copyright information in PMC

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