Lipid lowering Injectable Clinic-Novel Idea for Improving Compliance with Twice Yearly Dosing of Inclisiran

Abstract

Background/Synopsis

Inclisiran is a first-in-class small interfering ribonucleic acid (siRNA) which prevents hepatic PCSK9 production. It is indicated as an adjunct to diet or in combination with other cholesterol-lowering medications for adults with Heterozygous familial hypercholesterolemia, clinical atherosclerotic cardiovascular disease and expanded indication for primary prevention for patients with high LDL and without a history of cardiovascular disease. It is administered every 6 months (after initial and 3-month doses) providing a convenient approach to lower LDL cholesterol in a clinic setting. If a scheduled administration is missed by less than 3 months inclisiran should be given as soon as possible and continued the regular schedule. If it is missed by more than 3 months inclisiran dosing schedule should be restarted again.

Objective/Purpose

A dedicated clinic was started under the supervision of Dr. Sarah Qureshi to provide team-based care for the patients who were started on inclisiran in the practice to improve compliance.

Methods

Clinic lead was responsible for facilitating the clinic by coordinating with the physicians, pharmacists scheduler and clinic nurse. After the first dose of inclisiran was prescribed by the physician, the specialty pharmacists will obtain insurance approval. After the approval was obtained, the patient was notified and a clinic visit was scheduled. Inclisiran was administered at the clinic visit and the patient was educated by the clinic nurse about the side effects. A telephone visit was done 1 week prior to next injection for any side effects and prescribing the medicine. Monthly meetings were conducted to review patient's clinical progress.

Results

A total of 204 were prescribed inclisiran from July 26, 2021 - December 31, 2023. 152 patients are on schedule. 52 patients stopped follow up in the clinic:

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  29 refused when contacted to come for the initial injection.

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  8 patients stopped after one dose (6 after the 1st dose, 1 after the 2nd dose and 1 after the 3rd dose).

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  3 patients moved on to different clinic.

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  2 were non responders and switched to other PCSK9 inhibitors.

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  2 stopped due to terminal care.

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  3 rejected by insurance.

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  5 were unreachable.

Conclusions

Team-based care for twice yearly dosing of Inclisiran improves adherence to therapy, monitoring of side effects with minimal effort from the prescribing physician.