LDL-C Goal Attainment in Patients who Remain on Atorvastatin or Switch to Equivalent or Non-equivalent Doses of Simvastatin: A Retrospective Matched Cohort Study in Clinical Practice

Abstract

Continuing atorvastatin was associated with lower LDL-C levels and better LDL-C target attainment compared with switching to simvastatin. Patients switched to an equivalent simvastatin dose had lower LDL-C levels and were more likely to achieve LDL-C targets than patients switched to a non-equivalent dose, suggesting physicians must consider dosage equivalence when switching statins, and should measure LDL-C and titrate statins as necessary to achieve LDL-C control.

Potential cardiovascular consequences of switching from atorvastatin to generic simvastatin in the Netherlands

“…Similar to our findings, a recent US study by Rublee and Burke [14] noted that among 1048 patients who were switched from atorvastatin to simvastatin, switching was from a mean daily dose of 20.9 mg (±15.3) to a mean daily dose of 32.6 mg (±17.9).…”

Compliance after switching from branded to generic statins

“…However, negative views regarding the quality, safety, and efficacy of generic drugs persist among some patients, which may hinder compliance to these medications . Furthermore, replacing a branded statin with the generic of another statin (i.e., therapeutic substitution) has been associated with potentially inadvertent dose decreases or increases . Accordingly, to optimize patient compliance with statin therapy, we need to better understand the impact of switching from branded to generic agents.…”

Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients

“…Nonetheless, these results are consistent with previous findings after highefficacy statin switches to equivalent or lower efficacy doses of simvastatin. [20][21][22]29,30 Overall, this study illustrates how increased generic use without careful consideration of patient risk factors and current therapy can lead to switches to less efficacious dosages, higher LDL-C levels, and lower goal attainment rates. This information may help to inform physicians when considering therapeutic options.…”

“…18 The likelihood of LDL-C goal attainment has been observed to be lower on less efficacious versus higherefficacy statins in diabetic patients, 19 as in other populations. 10,[20][21][22] The National Committee for Quality Assurance has reported that the rates of LDL-C goal attainment (,100 mg/dL) in 2007 (change from 2006) in participating U.S. managed care plans, Medicare, and Medicaid for diabetes patients were 43.8% (10.8), 46.8% (20.1), and 31.3% (10.7), respectively. 23 It is worth noting that the rates of LDL-C control have remained stable or decreased slightly for diabetics during 2005 to 2007, possibly reflecting switches to less efficacious simvastatin doses.…”