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Cited by 7Medication Adherence and ComplianceLipoproteins and Cardiovascular HealthHeart Failure Treatment and Management

Adherence to PCSK9 Inhibitors in Clinical Practice

Open access
Blais, Joseph Edgar, Zhong, Wenfang, Li, Cheuk Ying Vanessa, Kongkaew, Chuenjid, Chan, Amy Hai Yan·2026·JACC: Advances
DOI 10.1016/j.jacadv.2026.102733PMC PMC13098587
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Abstract

BACKGROUND: Medication nonadherence is a barrier to the long-term effectiveness of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in clinical practice. OBJECTIVES: The aim of the study was to determine the prevalence of adherence to PCSK9 inhibitors in real-world practice across all adherence phases. METHODS: MEDLINE, EMBASE, PsycINFO, CINAHL Plus, and medRxiv were searched from inception to August 2, 2024. Observational studies reporting at least 1 quantitative adherence measure for alirocumab, evolocumab, or inclisiran were included. Study quality was assessed with the Joanna Briggs Institute checklist for prevalence studies. Data were pooled using random-effects meta-analysis with multilevel models to account for measurements at multiple time points. Measures of medication adherence were categorized into initiation, implementation (medication possession ratio [MPR] and proportion of days covered), and persistence (persistence and discontinuation) phases. RESULTS: = 98.9%). Multilevel meta-analyses demonstrated declines in MPR and persistence beyond 12 months of follow-up. CONCLUSIONS: 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.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found that PCSK9 inhibitor initiation is high in real-world practice, but implementation and persistence decline over time. The authors conclude that strategies are needed to sustain adherence, with limited long-term and inclisiran-specific evidence.

Key findings

  • Initiation was high at 91.7% (95% CI: 83.6-96.0; I² = 94.2%).
  • Implementation declined over time: pooled MPR was 95.1% (95% CI: 92.7-97.5) at 6 months and 86.5% (95% CI: 80.2-92.9) at 24 months; 12-month PDC was 69.7% (95% CI: 55.9-83.5). Adherence ≥80% at 12 months was 52.7% (95% CI: 30.0-74.4) using the total population denominator but 92.7% (95% CI: 85.4-96.5) using the persistent population denominator.
  • Persistence at 12 months was 81.8% (95% CI: 68.2-90.4), and the 12-month discontinuation rate was 12.1% (95% CI: 7.4-19.0). Mean time from initiation to permanent discontinuation was 8.00 months (95% CI: 4.57-13.98).
  • In multilevel models, MPR decreased from 91.9% short-term to 85.4% long-term, persistence decreased from 80.1% to 67.3%, and discontinuation increased from 13.5% to 22.3%. Resumption after temporary interruption was 50.4% (95% CI: 38.5-62.2), and switching between monoclonal antibodies was 3.6% (95% CI: 1.9-7.1).

Methods

  • Systematic review and meta-analysis registered on PROSPERO (CRD42024567957), reported per PRISMA 2020; searched MEDLINE, EMBASE, PsycINFO, CINAHL Plus, and medRxiv from inception to August 2, 2024.
  • Included observational cohort or cross-sectional studies reporting at least 1 quantitative adherence measure for alirocumab, evolocumab, or inclisiran; 94 studies were included in the systematic review, and 56 studies (n = 75,092 in the results text) contributed to quantitative synthesis.
  • Adherence measures were categorized into initiation, implementation (MPR, PDC, adherence ≥80%), persistence (persistence, discontinuation), and reinitiation (resumption, switching); random-effects meta-analysis used generalized linear mixed models, with three-level models for short-term (≤12 months) versus long-term (>12 months) follow-up. Study quality was assessed with the Joanna Briggs Institute prevalence checklist.

Limitations

  • The paper states clinical heterogeneity and variability in adherence measures across studies; the JBI prevalence tool may underestimate risk of bias for longitudinal outcomes such as persistence or discontinuation; meta-regression and subgroup analyses did not fully account for all heterogeneity.
  • The paper states limited inclisiran studies prevented comparison of inclisiran with monoclonal antibodies; most included studies were from high-income regions, limiting applicability to low- and middle-income settings; adherence may be overestimated because many studies were in specialty settings; reporting biases are possible.
  • Evident from the text: the abstract reports n = 75,902 for the 56 meta-analyzed studies, while the Results section reports n = 75,092; heterogeneity was very high for most pooled estimates (e.g., I² = 98.4%-99.8% for several implementation and persistence measures).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jacadv.2026.102733

Cites

125 of 129 references verified2 citation errors · 2 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

43 of 63 cited sources checked · 17 supported · 3 flagged · accuracy not yet measured

  • Interpretationcitation

    First-year discontinuation of PCSK9 inhibitor monoclonal antibodies can lead to suboptimal LDL cholesterol reduction compromising prevention of cardiovascular events.

    “Studies of PCSK9 inhibitor moAbs have reported first-year discontinuation rates approaching 50%, which can lead to suboptimal LDL cholesterol reduction compromising prevention of cardiovascular events.5, 6, 7, 8, 9, 10, 11, 12, 13”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [5] Alonso, 2023, Persistence with long-term PCSK9 inhibitor treatment and its effectiveness in familial hypercholesterolaemia: data from the SAFEHEART study, European J Prev Cardiol source
    • cites [6] Arca, 2023, Real-world effectiveness of PCSK9 inhibitors in reducing LDL-C in patients with familial hypercholesterolemia in Italy: a retrospective cohort study based on the AIFA monitoring registries, J Am Heart Assoc source

      In Results, the paper reports 85.83% persistence at 12 months among the HeFH patients analyzed, rather than first-year discontinuation approaching 50%. In Discussion, it explicitly excludes lack of adherence as an explanation for patients not reaching LDL-C targets and instead points to high LDL-C at treatment initiation. The paper does not assess whether discontinuation compromised prevention of cardiovascular events. (LLM, conf=0.85)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [7] Chng, 2022, Safety, adherence and efficacy of PCSK9 inhibitors: a retrospective real-world study, Proc Singap Healthc source
  • Premisecitation

    Studies of PCSK9 inhibitor monoclonal antibodies have reported first-year discontinuation rates approaching 50%.

    “Studies of PCSK9 inhibitor moAbs have reported first-year discontinuation rates approaching 50%, which can lead to suboptimal LDL cholesterol reduction compromising prevention of cardiovascular events.5, 6, 7, 8, 9, 10, 11, 12, 13”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [5] Alonso, 2023, Persistence with long-term PCSK9 inhibitor treatment and its effectiveness in familial hypercholesterolaemia: data from the SAFEHEART study, European J Prev Cardiol source

      The Introduction (page unavailable) says some studies found that almost 40% discontinued PCSK9 inhibitors within six months. The Persistence with PCSK9 inhibitors section (page unavailable) reports 30–40% first-year non-persistence in non-FH populations, not a rate approaching 50%; SAFEHEART’s own first-year rate was 1.3%. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [6] Arca, 2023, Real-world effectiveness of PCSK9 inhibitors in reducing LDL-C in patients with familial hypercholesterolemia in Italy: a retrospective cohort study based on the AIFA monitoring registries, J Am Heart Assoc source

      The Results (Adherence to and Effectiveness of PCSK9i Therapy in HeFH; page unavailable) report 85.83% persistence at 12 months, rather than first-year discontinuation approaching 50%. The Discussion describes persistence and adherence as remarkably high in practice. (LLM, conf=0.84)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [7] Chng, 2022, Safety, adherence and efficacy of PCSK9 inhibitors: a retrospective real-world study, Proc Singap Healthc source
  • Premisecitation

    The FOURIER open-label extension study reported a 14.0% overall premature discontinuation rate over 5 years among 6,635 patients randomized to evolocumab.

    “Regarding the persistence phase, the FOURIER open-label extension study reported a 14.0% overall premature discontinuation rate over 5 years among 6,635 patients randomized to evolocumab.115,116”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [115] Sabatine, 2017, Evolocumab and clinical outcomes in patients with cardiovascular disease, N Engl J Med source

      The Trial Design and Oversight section describes FOURIER as a randomized, double-blind, placebo-controlled trial, not an open-label extension. The Patients section reports 13,784 patients randomized to evolocumab, 12.5% premature permanent discontinuation, and a median follow-up of 26 months—not 6,635 patients, 14.0%, and five years. No page numbers are available in our copy. (LLM, conf=0.89)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [116] O'Donoghue, 2022, Long-term evolocumab in patients with established atherosclerotic cardiovascular disease, Circulation source

      The Results report 14.0% premature study-drug discontinuation among patients originally randomized to evolocumab. They also state that 6,635 patients enrolled in FOURIER-OLE, but only 3,355 of them had been randomized to evolocumab in the parent trial; the other 3,280 had been randomized to placebo. Median follow-up in the extension was 5.0 years. Thus, the rate and timeframe are supported, but the claimed group of 6,635 randomized to evolocumab is not. (LLM, conf=0.92)

      Experimental — accuracy not yet measured
  • Premisecitation

    Real-world data remain limited and inconclusive regarding whether inclisiran yields better adherence than monoclonal antibodies.

    “While inclisiran’s twice-yearly dosing regimen is hypothesized to enhance medication adherence,14 real-world data remain limited and inconclusive regarding whether inclisiran yields better adherence than moAbs.15,16”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [15] Mulder, 2023, First clinical experiences with inclisiran in a real-world setting, J Clin Lipidol source

      The Strengths and Limitations section (page unavailable) describes a small, single-clinic real-world study requiring longer follow-up, supporting the claim that evidence is limited. The Adherence and side effects section (page unavailable) reports inclisiran discontinuation, but does not compare adherence with monoclonal antibodies or conclude whether inclisiran improves it. (LLM, conf=0.74)

      Experimental — accuracy not yet measured
    • cites [16] Padam, 2022, Lipid lowering with inclisiran: a real-world single-centre experience, Open Heart source

      The Discussion describes this as the first real-world report on inclisiran’s LDL-c reduction, with only two months of follow-up, supporting the point that real-world evidence was limited. It notes that no patient discontinued after the first dose and says this could improve adherence, but it does not compare adherence with monoclonal antibodies or assess whether inclisiran yields better adherence. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Premisecitation

    A pooled analysis of 6 randomized, double-blind, controlled ODYSSEY trials demonstrated high implementation to alirocumab, with mean overall treatment adherence 98.0% (SD 4.4) over 1 to 2 years.

    “A pooled analysis of 6 randomized, double-blind, controlled ODYSSEY trials, demonstrated high levels of implementation to alirocumab, with a mean (SD) overall treatment adherence of 98.0% (4.4) over 1 to 2 years.114”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [114] Farnier, 2017, Long-term treatment adherence to the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab in 6 ODYSSEY Phase III clinical studies with treatment duration of 1 to 2 years, J Clin Lipidol source

      The Adherence section reports high mean overall adherence of 98.0% in the alirocumab arm, and the paper describes a pooled analysis of six randomized, double-blind, controlled ODYSSEY trials over 1 to 2 years. The passages available from our copy do not state the claimed SD of 4.4, so that numerical detail is not verified. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • May combine two claims. 41
  • Classified as probably not a substantial claim. 32

  • May combine two claims.

    Premisecitation

    PCSK9 inhibitors profoundly reduce LDL cholesterol levels and lower cardiovascular risk.

    “Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors profoundly reduce low-density lipoprotein (LDL) cholesterol levels and lower cardiovascular risk.1”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [1] Guedeney, 2022, Efficacy and safety of alirocumab and evolocumab: a systematic review and meta-analysis of randomized controlled trials, Eur Heart J source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This study-level systematic review was reported following PRISMA 2020 recommendations.

    “This study-level systematic review was managed in Covidence (Veritas Health Innovation) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 recommendations (Supplemental Table 1).17”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] Page, 2021, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, BMJ source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Study quality was assessed with the Joanna Briggs Institute prevalence critical appraisal tool, with two reviewers independently conducting assessment and discrepancies resolved with a third reviewer.

    “Two reviewers independently conducted the quality assessment using the JBI tool, with any discrepancies resolved through discussion with a third reviewer.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [18] Munn, 2014, The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence, Int J Health Policy Manag source
    • cites [19] Munn

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [20] Migliavaca, 2020, Quality assessment of prevalence studies: a systematic review, J Clin Epidemiol source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A random-effects model using a generalized linear mixed model was employed for pooling studies.

    “Given the anticipated statistical heterogeneity, consistent with previous adherence studies,23, 24, 25 we employed a random-effects model using a generalized linear mixed model for pooling studies.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [23] Kronish, 2011, Meta-analysis: impact of drug class on adherence to antihypertensives, Circulation source
    • cites [24] Ofori-Asenso, 2018, Adherence and persistence among statin users aged 65 years and over: a systematic review and meta-analysis, J Gerontol A Biol Sci Med Sci source
    • cites [25] Ofori-Asenso, 2021, Poor adherence and persistence to sodium glucose co-transporter 2 inhibitors in real-world settings: evidence from a systematic review and meta-analysis, Diabetes Metab Res Rev source

      Section 2.3 (page not provided) says the paper pooled studies with a random-effects model because of anticipated between-study heterogeneity. It describes using Freeman–Tukey double-arcsine transformed proportions, not a generalized linear mixed model, so that methodological detail is unsupported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    A study with a JBI score of ≥6 was considered to be at low risk of bias.

    “In line with previous studies, a study with a score of ≥6 was considered to be at low risk of bias.21,22”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [21] Ho, 2019, Incidence and prevalence of falls in adults with intellectual disability living in the community: a systematic review, JBI Database Syst Rev Implement Rep source

      The Methodological quality section says studies scoring 6–8 out of 9 on the JBI checklist were of acceptable quality for inclusion in the meta-analysis. It does not classify a score of ≥6 as low risk of bias: the Assessment of methodological quality section allowed studies scoring 5 into the review, and the GRADE Certainty Assessment and Results section rated risk of bias serious for every group of studies. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [22] Vijenthira, 2020, Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients, Blood source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    If a meta-analysis had adequate power (≥10 cohorts), funnel plots were generated and Egger test used to assess small study effects.

    “If a meta-analysis of a medication adherence measure had adequate power (ie, ≥10 cohorts), funnel plots were generated and visually inspected, and the Egger test was used to assess for small study effects (funnel plot asymmetry) potentially caused by reporting bias.30”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [30] Sterne, 2011, Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials, BMJ source

      Box 2 recommends avoiding asymmetry tests with fewer than 10 studies and interpreting results alongside visual inspection of funnel plots. It permits Egger’s test for continuous outcomes, but the guidance concerns randomised controlled trials, not cohorts, and notes that even 10 studies may be insufficient when heterogeneity is substantial. It does not establish that the citing authors’ analyses had adequate power. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Nearly all studies (n = 85) evaluated medication adherence to moAb PCSK9 inhibitors, while 7 studies evaluated siRNA PCSK9 inhibitor, of which 2 were included in meta-analysis.

    “Nearly all studies (n = 85) evaluated medication adherence to moAb PCSK9 inhibitors, while 7 studies evaluated siRNA PCSK9 inhibitor, of which 2 were included in meta-analysis.15,70”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [15] Mulder, 2023, First clinical experiences with inclisiran in a real-world setting, J Clin Lipidol source

      The Patient inclusion and registry and Adherence and side effects sections describe a study of the siRNA PCSK9 inhibitor inclisiran that reports treatment discontinuation. The paper does not report the claimed counts of 85 monoclonal-antibody studies and 7 siRNA studies, or establish that 2 siRNA studies were included in a meta-analysis. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [70] Iqbal, 2024, First report of Inclisiran utilization for hypercholesterolemia treatment in real-world clinical settings in a Middle East population, Clin Ther source

      The Introduction identifies inclisiran as an siRNA PCSK9 inhibitor, but the paper reports a retrospective patient study, not a count of medication-adherence studies. Searches for the 85- and 7-study counts and the two studies included in a meta-analysis found no passage addressing those figures; the Discussion instead says longer follow-up is needed to assess adherence. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Proportions were combined using logit transformation to address CI estimates falling outside the zero to 1 range.

    “Proportions were combined using logit transformation to address the issue of CI estimates falling outside the zero to 1 range.29”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [29] Barker, 2021, Conducting proportional meta-analysis in different types of systematic reviews: a guide for synthesisers of evidence, BMC Med Res Methodol source

  • May combine two claims.

    Premisecitation

    Self-reported adherence is simple and cost-effective but prone to recall and social desirability bias.

    “Self-reported adherence is simple and cost-effective but prone to recall and social desirability bias.130,131,133,134”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [130] Anghel, 2019, An overview of the common methods used to measure treatment adherence, Med Pharm Rep source

      The Discussion’s ‘Indirect methods’ section describes self-reported methods as cheap and simple and says recall or reporting bias can lead them to overestimate adherence. It does not specifically identify social desirability as the source of reporting bias, so that more specific part of the claim is not established by our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [131] Forbes, 2018, A systematic literature review comparing methods for the measurement of patient persistence and adherence, Curr Med Res Opin source
    • cites [133] Adams, 1999, Evidence of self-report bias in assessing adherence to guidelines, Int J Qual Health Care source
    • cites [134] Sinnappah, 2023, A framework for understanding sources of bias in medication adherence research, Br J Clin Pharmacol source

      Table 3 in the Results maps both recall or memory bias and social desirability bias to questionnaire or interview adherence scores. The Discussion also identifies self-reports as subjective measures associated with bias. The passages from our copy do not establish that self-reported adherence is simple or cost-effective. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Inclisiran has been suggested as an alternative to monoclonal antibodies to enhance medication adherence.

    “The inclusion of emerging evidence on inclisiran is valuable since it has been suggested as an alternative to moAbs, to enhance medication adherence.14”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Lloyd-Jones, 2022, 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee, J Am Coll Cardiol source

  • May combine two claims.

    Premisecitation

    Persistence measures derived from databases such as claims data cannot confirm actual medication use and may misclassify patients who switch insurers as nonadherent.

    “Persistence measures derived from databases, such as claims data, cannot confirm actual medication use and may misclassify patients who switch insurers as nonadherent.130,131,134”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [130] Anghel, 2019, An overview of the common methods used to measure treatment adherence, Med Pharm Rep source

      The Discussion > Indirect methods passage says that pharmacy and insurance claims data measure medication possession, not actual intake, supporting the first part of the claim. It does not discuss patients switching insurers or being misclassified as nonadherent for that reason (no page number is available in our copy). (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [131] Forbes, 2018, A systematic literature review comparing methods for the measurement of patient persistence and adherence, Curr Med Res Opin source
    • cites [134] Sinnappah, 2023, A framework for understanding sources of bias in medication adherence research, Br J Clin Pharmacol source

      Framework development (section 2.2; page unavailable) distinguishes analysis of prescription or claims databases and medication-possession scores from observed medication-taking and biomarker measures. This supports the point that database-derived measures cannot confirm actual use. The paper does not address patients switching insurers or their resulting classification as nonadherent (searched: insurer and insurance switching). (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Encountered inconsistencies represent a common challenge in adherence-related research.

    “These encountered inconsistencies represent a common challenge in adherence-related research.3”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [3] De Geest, 2018, ESPACOMP Medication Adherence Reporting Guideline (EMERGE), Ann Intern Med source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review used a methodologically rigorous approach informed by standardized adherence metrics.

    “Lastly, we used a methodologically rigorous approach informed by standardized adherence metrics,3,4 conducted quality assessments via JBI critical appraisal checklist,19 and restricted the meta-analyses to fully reported studies, with sensitivity analyses to ensure robustness.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [3] De Geest, 2018, ESPACOMP Medication Adherence Reporting Guideline (EMERGE), Ann Intern Med source

      The EMERGE discussion (page not provided) describes a standardized adherence taxonomy and reporting criteria for defining and measuring adherence phases. That supports using a consistent framework, but it does not establish that the citing review used standardized adherence metrics or that its overall approach was methodologically rigorous. (LLM, conf=0.80)

      Experimental — accuracy not yet measured
    • cites [4] Vrijens, 2012, A new taxonomy for describing and defining adherence to medications, Br J Clin Pharmacol source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Data sources varied widely, with 29 studies integrating multiple data sources.

    “Data sources also varied widely, with 29 studies integrating multiple data sources.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Definitions of outcome measures for medication adherence phases varied across studies.

    “Definitions of outcome measures for medication adherence phases (initiation, adherence, persistence, and reinitiation) varied across studies, with specific outcome definitions and characteristics of individual studies summarized in Supplemental Table 4B.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Studies reporting on adherence implementation used various implementation measures.

    “Studies reporting on adherence implementation used various implementation measures”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the 56 studies, 2 (3.6%) evaluated alirocumab only, 10 (17.9%) evolocumab only, 41 (73.2%) moAb, and 3 (5.4%) inclisiran.

    “Among them, 2 studies (3.6%) evaluated alirocumab only, 10 studies (17.9%) evaluated evolocumab only, 41 studies (73.2%) evaluated moAb, and 3 studies (5.4%) evaluated inclisiran.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Overall 34 (61.8%) studies met the low risk of bias threshold (≥6 points), while 21 (38.2%) were classified as high-risk of bias.

    “Overall 34 (61.8%) studies met the low risk of bias threshold (≥6 points), while 21 (38.2%) were classified as high-risk of bias (Supplemental Figure 7).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Evidence is limited beyond 24 months of follow-up and for inclisiran.

    “With limited evidence beyond 24 months of follow-up and for inclisiran, additional long-term observational studies are essential to guide real-world management.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Studies were primarily conducted in the United States (n = 31) and Europe (n = 47) with the remainder from other regions (n = 16).

    “Studies were primarily conducted in the United States (n = 31) and Europe (n = 47) with the remainder from other regions (n = 16).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most studies were published as full journal articles (n = 60), with the remainder as conference abstracts or brief reports (n = 34).

    “Most studies were published as full journal articles (n = 60), with the remainder as conference abstracts or brief reports (n = 34).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Studies from Europe had the highest PDC, followed by the United States and other regions.

    “Studies from Europe had the highest PDC, followed by the United States and other regions”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Geographic variations were prominent in analyzable population studies, with Europe demonstrating the highest adherence (77.7%; 95% CI: 70.9-83.3), followed by the United States (36.7%; 95% CI: 16.3-63.5) and other regions (29.1%; 95% CI: 26.7-31.7).

    “Geographic variations were prominent in analyzable population studies, with Europe demonstrating the highest adherence (77.7%; 95% CI: 70.9-83.3), followed by the United States (36.7%; 95% CI: 16.3-63.5) and other regions (29.1%; 95% CI: 26.7-31.7)”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The mean age was 62.61 (SD 11.9) years, and 58.0% were males.

    “The mean (SD) age was 62.61 (11.9) years, 58.0% were males.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The discontinuation rate at 12 months ranged from 1.1% to 48.7%, implying higher heterogeneity, with a similarly high I2 of 99%.

    “the discontinuation rate at 12 months ranged from 1.1% to 48.7% (Supplemental Figure 8Fi) implying higher heterogeneity, with a similarly high I2 of 99%.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Findingown data

    Other regions showed highest resumption rate (57.9%, 95% CI: 54.1-61.5), vs the United States (50.4%, 95% CI: 48.6% to 52.1%) and Europe (46.7%, 95% CI: 23.0%-72.0%).

    “Other regions showed highest resumption rate (57.9%, 95% CI: 54.1-61.5), vs the United States (50.4%, 95% CI: 48.6% to 52.1%) and Europe (46.7%, 95% CI: 23.0%-72.0%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The highest discontinuation rates were observed in other regions (28.0%, 95% CI: 24.4-31.9), followed by the United States (21.1%, 95% CI: 12.0-34.6) and Europe (8.1%, 95% CI: 4.2-13.2).

    “The highest discontinuation rates were observed in other regions (28.0%, 95% CI: 24.4-31.9), followed by the United States (21.1%, 95% CI: 12.0-34.6) and Europe (8.1%, 95% CI: 4.2-13.2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The United States showed highest switching (6.3%, 95% CI: 2.8-13.4), followed by other regions (4.0%, 95% CI: 3.1-5.0), and substantially lower rates in Europe (1.3%, 95% CI: 0.3-4.6).

    “The United States showed highest switching (6.3%, 95% CI: 2.8-13.4), followed by other regions (4.0%, 95% CI: 3.1-5.0), and substantially lower rates in Europe (1.3%, 95% CI: 0.3-4.6).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Adherence ≥80% remained stable over time, with comparable estimates in short- and long-term PCSK9 inhibitor adherence measurements.

    “Adherence ≥80% remained stable over time, showing comparable estimates in both the short- and long-term.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Findingreasoning

    Patients with diabetes and older individuals demonstrated poorer adherence implementation.

    “Patients with diabetes and older individuals demonstrated poorer adherence implementation, potentially due to competing treatment demands or therapeutic inertia.126, 127, 128”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Study-level associations between patient characteristics and adherence reflect individual-level associations.

  • May combine two claims.

    Findingown data

    Our meta-analysis found much lower implementation than the ODYSSEY trials, with a pooled 12-month PDC of 69.7% and 24-month MPR of 86.5%.

    “In contrast, our meta-analysis found much lower implementation, with a pooled 12-month PDC of 69.7% and 24-month MPR of 86.5%.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Findingown data

    Heterogeneity was substantial across outcomes, with discontinuation rates showing the greatest between-study variability.

    “Heterogeneity was substantial across outcomes, with discontinuation rates showing the greatest between-study variability (Supplemental Table 11B).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Findingown data

    Our study found a nearly three-fold higher discontinuation rate of 7.2% across all studies and 6.3% at 3 months compared with ORION-8.

    “In contrast, our study found a nearly three-fold higher discontinuation rate of 7.2% across all studies and 6.3% at 3 months.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Findingreasoning

    Estimates for MPR at 6 months ranged from 92.1% to 99.4%, implying low heterogeneity despite an I2 of 98%.

    “estimates for MPR at 6 months ranged from 92.1% to 99.4% (Supplemental Figure 8i) implying low heterogeneity, despite an I2 of 98%”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Findingown data

    When stratified by data source, patient support programs recorded the longest persistence (18.00 months, 95% CI: 15.70-20.63), followed by outpatient specialty clinics (17.33 months, 95% CI: 15.80-19.01), while database studies showed markedly shorter persistence (5.83 months, 95% CI: 3.31-10.26).

    “When stratified by data source, patient support programs recorded the longest persistence (18.00 months, 95% CI: 15.70-20.63), followed by outpatient specialty clinics (17.33 months, 95% CI: 15.80-19.01), while database studies showed markedly shorter persistence (5.83 months, 95% CI: 3.31-10.26)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Studies from Europe demonstrated the longest mean persistence at 17.33 months (95% CI: 15.80-19.01), followed by other regions at 15.63 months (95% CI: 12.06-20.26), the United States showing the shortest duration at 4.70 months (95% CI: 2.90-7.62).

    “Studies from Europe demonstrated the longest mean persistence at 17.33 months (95% CI: 15.80-19.01), followed by other regions at 15.63 months (95% CI: 12.06-20.26), the United States showing the shortest duration at 4.70 months (95% CI: 2.90-7.62).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Only a limited number of studies on inclisiran were identified, even fewer with direct comparisons to monoclonal antibodies.

    “Despite an extensive literature search, only a limited number of studies on inclisiran were identified, even fewer with direct comparisons to moAbs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Adherence was often arbitrarily defined, with several studies using an MPR or PDC threshold of 80% or greater.

    “Adherence was often arbitrarily defined, several studies using MPR or PDC threshold of 80% or greater, despite its subjective nature and potential to oversimplify complex behaviors.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    Discontinuation was typically defined as a treatment gap exceeding a specific period, most commonly 90 days.

    “Similarly, discontinuation was typically defined as a treatment gap exceeding a specific period, most commonly 90 days.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Most included studies were conducted in high-income regions, while evidence from low- and middle-income regions remains scarce.

    “Most of the included studies were conducted in high-income regions, while evidence from low- and middle-income regions remains scarce.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    In this systematic review, initiation of PCSK9 inhibitor therapy was generally high, while implementation and persistence declined over time.

    “In this systematic review, initiation of PCSK9 inhibitor therapy was generally high, while implementation and persistence declined over time.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The second-generation PCSK9 inhibitor, inclisiran, is a small interfering RNA administered by health care professionals biannually during the maintenance phase.

    “The second-generation PCSK9 inhibitor, inclisiran, is a small interfering ribonucleic acid (siRNA) administered by health care professionals biannually during the maintenance phase.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Katzmann, 2024, PCSK9-directed therapies: an update, Curr Opin Lipidol source

  • May combine two claims.

    Premisecitation

    Currently available PCSK9 inhibitors are administered via injection and are typically intended for lifelong use.

    “Currently available PCSK9 inhibitors are administered via injection and are typically intended for lifelong use.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Katzmann, 2024, PCSK9-directed therapies: an update, Curr Opin Lipidol source

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Meta-analyses were restricted to studies published as full journal articles.

    “To ensure data completeness for quality assessment and methodological rigor, the meta-analyses were restricted to studies published as full journal articles.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two reviewers independently screened titles and abstracts, and full texts were independently assessed by two reviewers, with discrepancies resolved through discussion.

    “Two reviewers (V.C.Y.L., R.M., or J.E.B.) independently screened the titles and abstracts of study reports for potential relevance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data extraction was performed by one reviewer and independently checked by a second reviewer.

    “A second reviewer (V.C.Y.L., W.Z., or J.E.B.) independently checked all extracted data for accuracy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Review protocol was registered on PROSPERO (CRD42024567957) prior to conducting the initial literature search.

    “Review protocol was registered on PROSPERO CRD42024567957) prior to conducting the initial literature search.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Sensitivity analyses were performed to assess robustness of findings.

    “Sensitivity analyses were performed to assess the robustness of our findings.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Statistical heterogeneity was assessed using I2.

    “Statistical heterogeneity was assessed using I2.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The selection of specific time points for each adherence measure in our main analyses was based on whether the sample size was the largest.

    “The selection of specific time points for each adherence measure in our main analyses was based on whether the sample size was the largest.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    All studies used databases so no subgroup analysis was conducted.

    “All studies used databases so no subgroup analysis was conducted.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Three-level meta-analytic models were fit to account for dependency of estimates at multiple times within studies.

    “To account for the dependency of estimates at multiple times within studies, we fit three-level meta-analytic models with time periods (short-term or long-term) as a moderator.26”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Cheung, 2014, Modeling dependent effect sizes with three-level meta-analyses: a structural equation modeling approach, Psychol Methods source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    All studies used databases so subgroup analysis by data source could not be performed.

    “All studies used databases so subgroup analysis by data source could not be performed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Patients frequently initiate PCSK9 inhibitors, but both implementation and persistence diminish over time.

    “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.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Sensitivity analyses demonstrated comparable pooled results across all medication adherence measures at specific time points, supporting the robustness of the main findings.

    “Supplemental Table 12 summarizes the results of the sensitivity analyses, which demonstrated comparable pooled results across all medication adherence measures at specific time points, supporting the robustness of our main findings.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Interpretationown data

    Implementation and persistence decrease over time, with progressively more patients discontinuing PCSK9 inhibitor therapy in the long-term.

    “These findings suggest that implementation and persistence decrease over time, with progressively more patients discontinuing therapy in the long-term.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    This is the first systematic review to determine the prevalence of medication adherence to PCSK9 inhibitors across all adherence phases-initiation, implementation, persistence, and reinitiation.

    “This is the first systematic review to determine the prevalence of medication adherence to PCSK9 inhibitors across all adherence phases—initiation, implementation, persistence, and reinitiation (Central Illustration).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    There was limited evidence of funnel plot asymmetry, and Egger's tests were not statistically significant.

    “There was limited evidence of funnel plot asymmetry (Supplemental Figure 13), and Egger's tests were not statistically significant (Supplemental Table 13).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

  • May combine two claims.

    Interpretationreasoning

    The superior adherence in patient support programs and specialty clinics compared to database studies reflects differences in patient selection and structures of care, where patients are often highly motivated and additional resources are available to resolve barriers to medication adherence.

    “This reflects differences in patient selection and structures of care in specialty clinics settings, where patients are often highly motivated and additional resources are available to proactively resolve barriers to medication adherence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Prior work has shown that studies of prevalence have a median I2 of 96.9%, although this does not always correspond to high heterogeneity and I2 should therefore be interpreted with care.

    “Prior work has shown that studies of prevalence have a median I2 of 96.9%, although this does not always correspond to high heterogeneity and I2 should therefore be interpreted with care.125”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [125] Migliavaca, 2022, Meta-analysis of prevalence: I(2) statistic and how to deal with heterogeneity, Res Synth Methods source

  • May combine two claims.

    Interpretationcitation

    The association between hypertension/elevated lipids and reduced persistence likely reflects the asymptomatic nature of these conditions and the pill burden of managing multiple cardiovascular medications.

    “This likely reflects both the asymptomatic nature of these conditions—leading to patient perceptions of wellness without medication—and the pill burden associated with managing multiple cardiovascular medications.129”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [129] Frishman, 2007, Importance of medication adherence in cardiovascular disease and the value of once-daily treatment regimens, Cardiol Rev source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The meta-analyses were restricted to fully reported studies.

    “Lastly, we used a methodologically rigorous approach informed by standardized adherence metrics,3,4 conducted quality assessments via JBI critical appraisal checklist,19 and restricted the meta-analyses to fully reported studies, with sensitivity analyses to ensure robustness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Some clinical heterogeneity among patients and variability in adherence measures exist across the included studies.

    “Despite strict eligibility criteria, some clinical heterogeneity among patients and variability in adherence measures exist across the included studies, which could complicate cross-study comparisons and introduce bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Statistical heterogeneity across studies was expected and explored through meta-regression and subgroup analyses, but these approaches did not fully account for all heterogeneity.

    “While statistical heterogeneity across studies was expected and explored through meta-regression and subgroup analyses, these approaches did not fully account for all heterogeneity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Reporting biases such as selective outcome reporting and unpublished data are possible, especially among observational studies.

    “Lastly, reporting biases such as selective outcome reporting and unpublished data are possible, especially among observational studies, where study registration is not required for publication.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Sensitivity analyses were performed to ensure robustness.

    “Lastly, we used a methodologically rigorous approach informed by standardized adherence metrics,3,4 conducted quality assessments via JBI critical appraisal checklist,19 and restricted the meta-analyses to fully reported studies, with sensitivity analyses to ensure robustness.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review conducted quality assessments via the JBI critical appraisal checklist.

    “Lastly, we used a methodologically rigorous approach informed by standardized adherence metrics,3,4 conducted quality assessments via JBI critical appraisal checklist,19 and restricted the meta-analyses to fully reported studies, with sensitivity analyses to ensure robustness.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Munn

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

67 of 67

  • The paper relies on this without support.

    Adherence tends to be higher in trial participants due to more controlled setting.

    “RCTs were not included, as our objective was to evaluate adherence in real-world clinical practice rather than in trial participants, where adherence tends to be higher due to more controlled setting.”

  • The paper relies on this without support.

    The adherence measures from the included studies are sufficiently comparable to be pooled in meta-analyses.

    “Three-level random effects meta-analyses showed that MPR and the proportion of persistent patients were lower in the long-term compared to short-term (Table 2).”

  • The paper relies on this without support.

    Study-level associations between patient characteristics and adherence reflect individual-level associations.

    “Our meta-regression analysis identified several potentially important study-level predictors of PCSK9 inhibitor adherence. Patients with diabetes and older individuals demonstrated poorer adherence implementation, potentially due to competing treatment demands or therapeutic inertia.126, 127, 128”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different participant totals are reported for the meta-analysis

    Minor

    The abstract reports 75,902 participants in the 56-study quantitative synthesis, whereas the Results section reports 75,092 for the same 56 studies.

  • Inclisiran meta-analysis study count differs

    Minor

    The Results section says three eligible meta-analysis studies evaluated inclisiran, but the narrative synthesis says two siRNA studies were included in the meta-analysis.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 9

  1. Cadenas, 2018, Anti-PCSK9 in everyday clinical practice, Eur J Prevent Cardioly, 25, S36
  2. Dalla Valle, 2020, Side effects of treatment with PCSK9I, expected or unexpected?, Eur Heart J Supp, 22, G1
  3. Dominguez, 2020, Alirocumab and evolocumab: results in clinical practice, Eur J Hos Pharmacy, 27, A56
  4. Gao, 2023, A retrospective analysis of adherence in Chinese ischemic stroke and transient ischemic attack patients treated with PCSK9 monoclonal antibody for 6 months, Eur Stroke J, 8, 558
  5. Lorena Martin Polo, 2019, PCSK9 inhibitors use in clinical practice: a tertiary hospital experience, Eur J Prevent Cardiol, 26
  6. Pandey, 2017, Abstract 19570: efficacy and barriers to evolocumab therapy in real-world, high risk secondary prevention patients not at LDL targets, Circulation, 136, A19570
  7. Starner, 2016, PCSK9i utilization, cost, utilization management impact, and discontinuation rate among 13 million commercially insured Americans, J Manag Care Spec Pharm, 22, S55
  8. Weber, 2019, PCSK9 compliance, a single center experience, Clin Cardiol, 42, S46
  9. Wiener, 2020, Real world treatment patterns following the initiation of proprotein convertase subtilisin/kexin type 9 antibody inhibitors among adults in the United States, 2015-2019, Pharmacoepidemiol Drug Safety, 29, 55

Cited by

Sorted by citations

Authors
Blais, J. E., Zhong, W., Li, C. Y. V., Kongkaew, C., & Chan, A. H. Y.
Affiliations
  • University of Hong Kong (HK)
  • Naresuan University (TH)
  • University of Auckland (NZ)
Corresponding author
Blais, Joseph Edgar
ORCID
Venue
JACC: Advances
Publisher
Elsevier BV
Published
2026-05
Volume
5
Issue
5
Pages
102733
ISSN
2772-963X (ISSN-L)
DOI
10.1016/j.jacadv.2026.102733
PMC
PMC13098587
OpenAlex
W7154751533
Semantic Scholar
c6f618012f155762b56248082664972738191a49
Cited by
7
References
107
Citations by year
2026: 7
FWCI
66.26
Type
journal article
Language
en
Open access
Licence
Locations
  • JACC Advances (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
  • The University of Hong Kong
  • U.S. Food and Drug Administration
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
PCSK9 inhibitors, medication adherence, alirocumab, evolocumab, inclisiran, medication possession ratio, proportion of days covered, treatment persistence, treatment discontinuation, hypercholesterolemia, LDL cholesterol lowering

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-19.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-19.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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