In this blog, during National Cholesterol Month, Programme Manager Adele Bunch highlights the new cholesterol lowering drug being implemented at scale to compliment the current lipid management pathway.
We’ve all heard of cholesterol: good cholesterol, bad cholesterol. But when we start to look at the diagnosis and treatment of lipid disorder, there’s a bit more to it. And when we consider the cardiovascular disease (CVD) prevalent population in the Yorkshire and Humber region, we know more intervention is needed to combat the rise of CVD deaths, which for the first time in 50 years is rising.
CVD has been identified in the NHS Long Term Plan as the biggest single area where the NHS can save lives in the next ten years – 150,000 to be exact. With heart disease causing one in four deaths in England, and two in five people in England thought to have high cholesterol, the rationale for prevention, diagnosis and treatment is clear.
The good news is that the current AHSN Network Lipid Management and Familial Hypercholesterolemia (FH) programme is making significant progress. It has increased the diagnosis and treatment of FH patients, including children and continues to do so. You can find out more about the programme in my colleague Labeeb Azim’s recent blog.
But what if a patient is on the maximum dosage of statins, has been prescribed rapid uptake products such as PCSK9i or ezetimibe and their levels are not decreasing? This is where Inclisiran comes in.
Inclisiran brings new science to the table using RNA interference (a biological process where molecules can shut down protein translation) to help the liver remove harmful LDL cholesterol (low density lipoprotein or simply known as ‘bad cholesterol’) from the blood. Designed to be used on its own or with statins, the injectable drug is administered initially, again after three months then every six months. In Yorkshire and Humber alone, it could benefit 65,000 people from now until the end of March 2024.
So, what’s the role of the Yorkshire & Humber AHSN in Inclisiran adoption? I am responsible for leading the regional implementation of Inclisiran and I’ve begun local conversations to discuss the current lipid-management pathway and where Inclisiran fits. As with any new drug there is a mix of excitement, concern and natural scepticism. Discussions are key and we at the AHSN are keen to understand any local barriers or challenges to help support local uptake.
I think it’s important to reinforce that Inclisiran is just one part of the lipid-management pathway. It will not be applicable to all patients with high cholesterol and can only be prescribed if someone has had a CVD event. However, in line with NICE guidance, for those patients where other treatments are not working, Inclisiran provides a new option and can reduce cholesterol levels by 50%.
The Accelerated Access Collaborative is currently developing a revised lipid pathway and Clinical Commissioning Groups (CCGs) and Trust leads should have had sight of a medicine’s optimisation pack and accompanying letter from NHS England and NHS Improvement (NHSEI). Conversations should now be taking place within local area prescribing committees to review and adopt Inclisiran, proceed with local formulary listing and allocation of funding to GP prescribing budgets.
So, what’s next? My ask of Integrated Care System leads, Trusts, Primary Care Networks (PCNs) and local lipid specialists is to drop me an email – let’s get the conversations started. Reach out to me at firstname.lastname@example.org