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Published Online, 25 April 2006, www.theannals.com, DOI 10.1345/aph.1G639.
 The Annals of Pharmacotherapy: Vol. 40, No. 5, pp. 818-823. DOI 10.1345/aph.1G639
© 2006 Harvey Whitney Books Company.
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DYSLIPIDEMIA

Type Of Preexisting Lipid Therapy Predicts LDL-C Response to Ezetimibe

Charles D Meyers, MD

Associate Director, Atherosclerosis Research Center; Staff Physician, Veterans Affairs Long Beach Healthcare System, Long Beach, CA

Yong SK Moon, PharmD

Assistant Professor, Thomas J Long School of Pharmacy, University of the Pacific, Stockton, CA

Hoda Ghanem, MD

Resident Physician, Department of Medicine, University of California, Irvine, CA

Nathan D Wong, PhD

Director, Heart Disease Prevention Program, University of California, Irvine

Reprints: Dr. Meyers, Atherosclerosis Research Center, VA Long Beach Healthcare System, 5901 E. 7th St. (11-111I), Long Beach, CA 90822-5201, fax 562/826-5515, daniel.meyers{at}med.va.gov

BACKGROUND: Ezetimibe as monotherapy or in combination with statins effectively lowers low-density lipoprotein cholesterol (LDL-C). However, there are few reports of ezetimibe's effect when added to ongoing non-statin lipid-lowering drugs or combination lipidlowering therapy.

OBJECTIVE: To evaluate the impact of preexisting lipid therapy on LDL-C response to ezetimibe.

METHODS: We performed a retrospective review of all patients started on ezetimibe therapy at the Veterans Affairs Long Beach Healthcare System between March 1, 2003, and March 1, 2005. We calculated the ezetimibe-induced percent change in LDL-C in patients without concomitant changes in other lipid-lowering medications. We then stratified the population according to the type and number of preexisting lipid therapies and compared the LDL-C-lowering efficacy of ezetimibe among these groups.

RESULTS: Overall, ezetimibe was associated with a 23.0% reduction in LDL-C. Patients with preexisting statin monotherapy had significantly greater LDL-C reduction with ezetimibe than did those with preexisting non-statin drugs (-26.1% vs -9.3%; p = 0.0138). In patients with no preexisting lipid therapy (n = 58), monotherapy (n = 115), double therapy (n = 36), or triple therapy (n = 9), ezetimibe decreased LDL-C by 17.3%, 21.4%, 33.5%, and 38.1%, respectively. This stepwise trend in increased ezetimibe efficacy was statistically significant, even with adjustments for baseline LDL-C.

CONCLUSIONS: Ezetimibe's LDL-C-lowering effects are most pronounced when added to preexisting combination lipid therapy. It appears to be more effective when added to statin therapy compared with other lipid-lowering therapies.

Key Words: combination therapy, dyslipidemia, ezetimibe

Published Online, April 25, 2006. www.theannals.com, DOI 10.1345/aph.1G639




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