Adherence to PCSK9 Inhibitors in Clinical Practice: Systematic Review and Meta-Analysis of Observational Studies
Authors' conclusion
Although patients frequently initiate PCSK9 inhibitors, both implementation and persistence diminish over time, underscoring the need for strategies that sustain medication adherence in clinical practice. With limited evidence beyond 24 months of follow-up and for inclisiran, additional long-term observational studies are essential to guide real-world management.
Study context
- Population
- Patients using PCSK9 inhibitors (alirocumab, evolocumab, or inclisiran) in real-world practice56 studies contributing to quantitative synthesis, 94 studies in the systematic review
- Participants
- 75,902 patients
- Outcome
- Initiation
Methodological detailsrandom-effects meta-analysis with multilevel models, observational studies
- Random-effects meta-analysis with multilevel models
- Observational studies
Pooled result
As reported in the abstract
Initiation
91.7%
95% CI 83.6–96.0; I2 = 94.2%
Further pooled results
Medication possession ratio (MPR) · 6 months and 24 months
- MPR at 6 months
- 95.1% (95% CI: 92.7-97.5; I2 = 98.4%)
- MPR at 24 months
- 86.5% (95% CI: 80.2-92.9; I2 = 99.7%)
Proportion of days covered · 12 months
- Proportion of days covered
- 69.7% (95% CI: 55.9-83.5; I2 = 99.8%)
Persistence and discontinuation · 12 months
- Persistence
- 81.8% (95% CI: 68.2-90.4; I2 = 99.1%)
- Discontinuation rate
- 12.1% (95% CI: 7.4-19.0; I2 = 98.9%)
MPR and persistence beyond 12 months
- Declines in MPR and persistence beyond 12 months of follow-up
- Multilevel meta-analyses
Original publication
Adherence to PCSK9 Inhibitors in Clinical Practice: Systematic Review and Meta-Analysis of Observational Studies. JACC Adv. Published 17 April 2026. doi:10.
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