Improving Statin Therapy Adherence: New Recommendations

Improving Statin Therapy Adherence: New Recommendations
Reid Larson, PharmD, Welia Health

If you are a pharmacist working in a clinical setting, it is likely a frequent occurrence that you have a discussion of statin-induced myalgias with your patients. While a recent meta-analysis showed the prevalence of statin intolerance is less than 10%, approximately one-half of patients stop taking statins, reduce the dose, or take them irregularly due to fears of adverse effects (AEs). The International Lipid Expert Panel (ILEP) recently published new recommendations that could help practitioners better identify patients with true statin-intolerances, manage statin-intolerances, and prevent the development of AEs with statin use.

ILEP recommendations, as published in Journal of Cachexia, Sarcopenia and Muscle, discuss the “nocebo/drucebo” effect. “Nocebo” (NO drug + plaCEBO) describes the AEs a patient may experience when given an inert tablet (no active ingredient), whereas “drucebo” (DRUg + plaCEBO) refers to the difference in AEs experienced when an active ingredient-containing tablet is taken, whether it is known or blinded that it is a statin. The ILEP discusses how to diagnose statin intolerance and exclude nocebo/drucebo effect, which should include: 1) intolerance in at least two different statins, even at their lowest doses; 2) laboratory confirmed abnormalities with statin use such as elevated creatine kinase; 3) symptoms either resolve or improve upon statin discontinuation; and 4) diagnostic exclusion of other possible etiologies (e.g. drug interactions, thyroid disorder, vitamin D deficiency, neuromuscular disorders, etc.).

The ILEP recommends creating a Personalized Lipid Intervention Plan (PLIP) for each patient. The PLIP is a one-page document which helps patients understand the risks and benefits of statin treatment, how to manage AEs if they do occur, and what non-pharmacological options are available to decrease the risk of heart attacks and strokes. Patients should be informed of their 10-year atherosclerotic cardiovascular disease (ASCVD) risk with and without statin therapy. In addition, routine follow-ups should be performed to check safety, efficacy, and adherence to statin therapy. If statin associated muscle pain does occur, the ILEP recommends utilizing the “MEDS” principle as follows: Minimizing disruption to therapy; Educating the patient regarding the benefits of statin therapy, using Diet and nutraceuticals to complement pharmaceutical lipid-lowering, and monitoring Symptoms and biomarkers.

As pharmacists, helping patients to make fully informed decisions about initiating/discontinuing any medications, statins included, is vital to promoting a feeling of empowerment for patients in their health and improving adherence to prescribed therapies.

References:

  1. Bytyçi I, Penson PE, Mikhailidis DP, et al. Prevalence of statin intolerance: a meta-analysis [published online ahead of print, 2022 Feb 16]. Eur Heart J. 2022;ehac015. doi:10.1093/eurheartj/ehac015.
  2. Penson, PE, et al. and International Lipid Expert Panel (ILEP) (2022). Step-by-step diagnosis and management of the nocebo/drucebo effect in statin-associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP), Journal of Cachexia, Sarcopenia and Muscle, doi: https://doi.org/10.1002/jcsm.12960.
  3. Murphy J. New Recommendations Seek to Improve Adherence to Statin Therapy. Pharmacy Times, Published April 7 2022. Accessed May 10, 2022. https://www.pharmacytimes.com/view/new-recommendations-seek-to-improve-a....