Achieving goal lipid levels with ezetimibe plus statin add-on or switch therapy compared with doubling the statin dose. A pooled analysis

Ambegaonkar, Baishali; Tipping, Diane; Polis, Adam B.; Tomassini, Joanne E.; Tershakovec, Andrew M.

doi:10.1016/j.atherosclerosis.2014.10.105

Cited by 36 publications

(24 citation statements)

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“…Ji et al found in their study that the LDL-C reduction was similar between ezetimibe-statin combination group and intensive statin group for patients suffered acute myocardial infarction (9), which was consistent with this study. In our study, the proportion of patients reaching LDL-C goal was higher in ezetimibe-statin combination group than moderate-intensity statin group, and this result was similar to other published studies (21). In addition, we found that the extent of LDL-C reduction and the proportion of patients reaching LDL-C goal were similar in ezetimibestatin combination group and intensive statins group.…”

Section: Discussionsupporting

confidence: 91%

Statin-ezetimibe versus statin lipid-lowering therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Dai

Zhang

et al. 2017

J. Thorac. Dis.

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Section: Discussionsupporting

confidence: 91%

Statin-ezetimibe versus statin lipid-lowering therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Dai

Zhang

et al. 2017

J. Thorac. Dis.

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“…The studies that added ezetimibe to a stable statin therapy showed a significant reduction of total cholesterol (ranging from −12.9% to −21%) and LDL-C (from 20.8% to 35%) with conflicting results about HDL and triglycerides. Ezetimibe represents an affordable choice in statin-intolerant patient and a good option to intensify statin therapy with a very low toxicity profile [ 67 – 73 ].…”

Section: Pharmacological Treatment Of Dyslipidemiamentioning

confidence: 99%

Cardiovascular risk and dyslipidemia among persons living with HIV: a review

Maggi¹,

et al. 2017

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BackgroundAim of this review is to focus the attention on people living with HIV infection at risk of developing a cardiovascular event. What is or what would be the most suitable antiretroviral therapy? Which statin or fibrate to reduce the risk? How to influence behavior and lifestyles?DiscussionPrevention of cardiovascular disease (CVD) risk remains the first and essential step in a medical intervention on these patients. The lifestyle modification, including smoking cessation, increased physical activity, weight reduction, and the education on healthy dietary practices are the main instruments.Statins are the cornerstone for the treatment of hypercholesterolemia. They have been shown to slow the progression or promote regression of coronary plaque, and could also exert an anti-inflammatory and immunomodulatory effect. However the current guidelines for the use of these drugs in general population are dissimilar, with important differences between American and European ones. The debate between American and European guidelines is still open and, also considering the independent risk factor represented by HIV, specific guidelines are warranted.Ezetimibe reduces the intestinal absorption of cholesterol. It is effective alone or in combination with rosuvastatin. It does not modify plasmatic concentrations of antiretrovirals. A number of experimental new classes of drugs for the treatment of hypercholesterolemia are being studied.Fibrates represent the first choice for treatment of hypertriglyceridemia, however, the renal toxicity of fibrates and statins should be considered.Omega 3 fatty acids have a good safety profile, but their efficacy is limited. Another concern is the high dose needed. Other drugs are acipimox and tesamorelin.Current antiretroviral therapies are less toxic and more effective than regimens used in the early years. Lipodistrophy and dyslipidemia are the main causes of long-term toxicities. Not all antiretrovirals have similar toxicities. Protease Inhibitors may cause dyslipidemia and lipodystrophy, while integrase inhibitors have a minimal impact on lipids profile, and no evidence of lipodystrophy. There is still much to be written with the introduction of new drugs in clinical practice.ConclusionsCardiovascular risk among HIV infected patients, interventions on behavior and lifestyles, use of drugs to reduce the risk, and switch in antiretroviral therapy, remain nowadays major issues in the management of HIV-infected patients.

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“…When the LDL-C goal is not achieved, the combination of statin with a cholesterol absorption inhibitor — ezetimibe — may be considered (class of recommendation IIa, level of evidence B) [2]. Statin dose titration seems to be less effective compared with the combined therapy with statin and ezetimibe [21]. The combination of statin with ezetimibe reduces the LDL-C by an additional 15–20% [22].…”

Section: Introductionmentioning

confidence: 99%

The impact of the time of drug administration on the effectiveness of combined treatment of hypercholesterolemia with Rosuvastatin and Ezetimibe (RosEze): study protocol for a randomized controlled trial

Obońska

Kasprzak

Sikora

et al. 2017

Trials

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BackgroundHypercholesterolemia is one of the main risk factors for cardiovascular disease. The first line treatment for hypercholesterolemia is statin therapy. When the expected low-density lipoprotein cholesterol (LDL-C) concentration is not achieved, the pharmacotherapy may be extended by combining the statin with the cholesterol absorption inhibitor ezetimibe.Methods/designThe study is designed as a randomized, open-label, single-center, crossover study evaluating the effectiveness of combined therapy with rosuvastatin and ezetimibe for hypercholesterolemia. The study is planned to include 200 patients with hypercholesterolemia ineffectively treated with statins for at least 6 weeks. After enrollment participants are randomized into one of two arms receiving rosuvastatin and ezetimibe. In the first arm the study drug is administered in the morning (8:00 am) for 6 weeks and then in the evening for the next 6 weeks; in the second arm the study drug is administered at first in the evening (8:00 pm) for the first 6 weeks and then in the morning for the following 6 weeks. In order to minimize non-adherence to the treatment, all patients will receive the study drug free of charge. The primary outcome of the study is change in LDL-C at 6 and 12 weeks of the treatment, depending on the time of day of study drug administration. The secondary endpoints include change in total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoproteins ApoB and Apo AI, non-HDL cholesterol, small, dense (sd)-LDL cholesterol, lipoprotein(a), glucose, glycated hemoglobin, high-sensitivity C-reactive protein, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, and creatine kinase at 6 and 12 weeks of the study drug treatment, as well as assessment of plasma fluorescence using stationary and time-resolved fluorescence spectroscopy at baseline and at 6 and 12 weeks of the therapy.DiscussionThe RosEze trial is expected to demonstrate whether there is a significant difference in the effectiveness of the lipid-lowering therapy in reducing the concentration of cholesterol when the medications are taken in the morning compared with the evening time of day.Trial registrationClinicalTrials.gov, NCT02772640. Registered on 28 March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2047-8) contains supplementary material, which is available to authorized users.

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Achieving goal lipid levels with ezetimibe plus statin add-on or switch therapy compared with doubling the statin dose. A pooled analysis

Cited by 36 publications

References 44 publications

Statin-ezetimibe versus statin lipid-lowering therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Statin-ezetimibe versus statin lipid-lowering therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention

Cardiovascular risk and dyslipidemia among persons living with HIV: a review

The impact of the time of drug administration on the effectiveness of combined treatment of hypercholesterolemia with Rosuvastatin and Ezetimibe (RosEze): study protocol for a randomized controlled trial

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