Is it associated with additional low-density lipoprotein cholesterol reduction benefits?




Main Takeaway

Low-density lipoprotein cholesterol (LDL-C) was further reduced by 31.0–41.0% after switching from a statin monotherapy to a statin plus ezetimibe therapy

  • Among the total enrolled patients, 88.3–90.1% of the patients successfully attained the target LDL-C goal of <100 mg/dL (all intensity groups, P <0.01)

Why This Matters

Though intense LDL-C management is recommended in order to attain desired targets, the percentage of patients attaining the target LDL-C remains substantially low

  • This real-world study evaluated the effect of switching from statin monotherapy to statin/ezetimibe combination therapy in terms of target LDL-C goals attained

Study Design

Retrospective study: electronic medical records of 4,252 patients from two Korean tertiary care medical centers (1 January 2015 - 31 December 2017)

  • Six statin/ezetimibe combinations were assessed: – Atorvastatin 10 mg plus ezetimibe 10 mg – Atorvastatin 20 mg plus ezetimibe 10 mg – Atorvastatin 40 mg plus ezetimibe 10 mg – Rosuvastatin 5 mg plus ezetimibe 10 mg – Rosuvastatin 10 mg plus ezetimibe 10 mg – Rosuvastatin 20 mg plus ezetimibe 10 mg

Study outcomes: LDL-C reductions; percentage of patients attaining LDL-C levels of <100 mg/dL after 3 months of combination treatment (vs baseline values)

Key Results

Effect of combination therapy on LDL-C levels after 3 months of treatment (vs baseline):

- Atorvastatin 10 mg plus ezetimibe or rosuvastatin 5 mg plus ezetimibe:

  • LDL-C level reduction = 31.0% (P <0.01)
  • Patients attaining LDL-C target (<100 mg/dL) = 88.3% vs 35.3% at baseline (P <0.01)

- Atorvastatin 20 mg plus ezetimibe or rosuvastatin 10 mg plus ezetimibe:

  • LDL-C level reduction = 36.4% (P <0.01)
  • Patients attaining LDL-C target = 90.1% vs 33.4% at baseline (P <0.01)

- Atorvastatin 40 mg plus ezetimibe or rosuvastatin 20 mg plus ezetimibe:

  • LDL-C level reduction = 41.0% (P <0.01)
  • Patients attaining LDL-C target = 87.5% vs 21.9% at baseline (P <0.01)

 

Switching from statin monotherapy to rosuvastatin plus ezetimibe exhibited greater LDL-C reductions than atorvastatin plus ezetimibe

 

- Patients switching from a low-intensity statin to combination therapy:

  • Atorvastatin (10, 20 mg) plus ezetimibe = 40.9%, 48.7%
  • Rosuvastatin (5, 10 mg) plus ezetimibe = 49.2%, 51.8%

- Patients switching from a moderate-intensity statin to combination therapy:

  • Atorvastatin (10, 20, 40 mg) plus ezetimibe = 32.8%, 36.1%, 37.3%
  • Rosuvastatin (5, 10, 20 mg) plus ezetimibe = 29.3%, 38.7%, 45.8%

- Patients switching from a high-intensity statin to combination therapy:

  • Atorvastatin (10, 20, 40 mg) plus ezetimibe = 12.4%, 27.6%, 37.4%
  • Rosuvastatin (5, 10, 20 mg) plus ezetimibe = 24.1%, 30.6%, 37.4%

Limitations

  • This study had the inherent limitations of retrospective studies, lacked information regarding patient adherence, and did not evaluate adverse effects
  • The percentages of patients attaining target LDL-C levels (<100 mg/dL) was calculated without classifying their risk factors
    Lee J, Lee SH, Kim H, Lee SH, Cho JH, Lee H, et al. Low-density lipoprotein cholesterol reduction and target achievement after switching from statin monotherapy to statin/ezetimibe combination therapy: Real-world evidence. J Clin Pharm Ther. 2020;46:134-142. doi: 10.1111/jcpt.13271.

MAT-QA-2100065/v1/Oct 2021