Retrospective Case Series of Patients with Diabetes or Prediabetes Who Were Switched from Omega-3-Acid Ethyl Esters to Icosapent Ethyl

Abstract

IntroductionPatients with diabetes and prediabetes are at increased risk of dyslipidemia and cardiovascular disease. To reduce this risk, statins and additional therapies may be considered. Omega-3 fatty acids offer an option to reduce triglycerides (TG) and potentially improve other lipid parameters, although products that contain docosahexaenoic acid (DHA) may increase low-density lipoprotein cholesterol (LDL-C) while eicosapentaenoic acid (EPA) does not. Prescription formulations include omega-3-acid mixtures (combination of predominantly EPA and DHA), and icosapent ethyl (high-purity prescription form of EPA ethyl ester); prescription omega-3 products are indicated as an adjunct to diet to reduce TGs in adult patients with severe hypertriglyceridemia at a dose of 4 g/day.MethodsThis was a retrospective analysis of records from a private endocrinology practice of patients who received omega-3-acid ethyl esters (OM3EE) (4 g/day) and were subsequently switched to icosapent ethyl (IPE; 4 g/day) due to the potential of OM3EE to raise LDL-C and/or cause gastrointestinal upset. Patient records were analyzed for LDL-C, TG, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and non-HDL-C measured before and after the switch to IPE.ResultsThe records of ten patients met the criteria for this analysis and were included. All patients had taken OM3EE for ≥1 year prior to their last lipid measurement before switching to IPE, and all had been taking IPE for >3 months at the time of their subsequent lipid measurement. Nine of the ten patients were on concomitant statin therapy throughout. Reductions in LDL-C, TC, and non-HDL-C were observed in eight patients, reductions or no changes in TG were observed in eight patients, and increases or no changes in HDL-C were observed in eight patients. No gastrointestinal adverse events were observed.ConclusionIn most patients with prediabetes or diabetes who switched from OM3EE to IPE, LDL-C and other lipid parameters improved. IPE was well tolerated.

Switching from EPA + DHA (Omega-3-acid Ethyl Esters) to High-Purity EPA (Icosapent Ethyl) in a Statin-Treated Patient with Persistent Dyslipidemia and High Cardiovascular Risk: A Case Study

“…Although this current report is limited to a single retrospective case and results may not necessarily be extrapolated to patients with different demographic and clinical characteristics, the collective evidence from this and other retrospective case reports/series published to date [24][25][26] suggests that improvements in lipid parameters may be achieved after switching from products containing both DHA and EPA to the prescription EPA-only product, icosapent ethyl. Taken together, these case studies suggest that a prospective clinical study examining the impact of such a switch with a much larger sample size may be warranted.…”

“…The lipid profile changes demonstrated in the current case study are consistent with other reports of patients being switched from EPA + DHA products to icosapent ethyl. 24–27 A retrospective chart review of 10 patients (9 treated with statins) with prediabetes or diabetes showed that switching from omega-3-acid ethyl esters 4 g/day to icosapent ethyl 4 g/day was well tolerated and resulted in improvements in the levels of LDL-C, TG, non-HDL-C, TC, and HDL-C for most patients. 24 Similarly, another retrospective case series of 15 patients (10 treated with statins) with elevated TG levels or hyperlipidemia showed that the switch from omega-3-acid ethyl esters 4 g/day to icosapent ethyl 4 g/day was associated with reductions in LDL-C, TG, non-HDL-C, and TC levels (changes in HDL-C levels were variable).…”

“…24–27 A retrospective chart review of 10 patients (9 treated with statins) with prediabetes or diabetes showed that switching from omega-3-acid ethyl esters 4 g/day to icosapent ethyl 4 g/day was well tolerated and resulted in improvements in the levels of LDL-C, TG, non-HDL-C, TC, and HDL-C for most patients. 24 Similarly, another retrospective case series of 15 patients (10 treated with statins) with elevated TG levels or hyperlipidemia showed that the switch from omega-3-acid ethyl esters 4 g/day to icosapent ethyl 4 g/day was associated with reductions in LDL-C, TG, non-HDL-C, and TC levels (changes in HDL-C levels were variable). 26 These findings are notable in that such patients, due to their atherogenic lipid profiles and/or other relevant conditions, may be at residual CV risk despite statin therapy.…”

Anti-Inflammatory Properties In Vitro and Hypoglycaemic Effects of Phenolics from Cultivated Fruit Body of Phellinus baumii in Type 2 Diabetic Mice

“…T2DM is characterized by higher FBG levels, lower glucose tolerance, and symptoms such as IR and dyslipidemia, etc. [ 37 ]. As expected, in the present study, FBG levels and OGTT were significantly increased in T2DM mice compared with the control mice, while intervention by PPE significantly reversed the upregulation of FBG and OGTT.…”

Prescription omega-3 fatty acid products: considerations for patients with diabetes mellitus

“…A “real-world” perspective on the use of prescription OM3FAs can be gained from a recent retrospective case series (n=10) of patients with diabetes or prediabetes in our private endocrinology practice. 72 The impact of switching from a prescription OM3FA containing a combination of DHA and EPA (omega-3-acid ethyl esters) to the EPA-only prescription product (icosapent ethyl) was assessed. Patients had been switched because of compliance issues caused by gastrointestinal side effects and fishy eructation experienced with the EPA+DHA formulation; the EPA-only formulation offered the potential for fewer gastrointestinal effects with no adverse effects on LDL-C levels.…”