| Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia: systematic review and meta-analysis. | |
| | |
MedLine Citation:
|
PMID: 21473671 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To systematically review and analyse evidence for cholesterol-lowering efficacy of at least 4 weeks of add-on ezetimibe vs doubling statin dose, in adults with primary hypercholesterolaemia. RESEARCH DESIGN AND METHODS: MEDLINE, EMBASE and Cochrane databases were searched to identify randomised controlled trials of ezetimibe-statin combination vs statin titration (January 1993 - March 2010). Studies were selected using predefined criteria. Two reviewers conducted screening of articles, critical appraisal and data extraction; a third reviewer resolved disagreements. The difference between treatments was analysed for four co-primary outcomes: mean percentage change from baseline in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC); and proportion of patients achieving LDL-C treatment goal. Data were combined by two sets of direct comparison fixed and random effects meta-analysis: (1) compared data in the same treatment period between groups; (2) compared the incremental change in lipid levels of add-on ezetimibe vs doubling statin dose. Heterogeneity was assessed using the I(2) statistic. RESULTS: Thirteen studies including 5080 patients were included in the meta-analyses. Data on simvastatin, atorvastatin and rosuvastatin were analysed. Results for primary and secondary outcomes were in favour of the ezetimibe-statin combination. A significantly greater percentage reduction in LDL-C levels was achieved in patients treated with ezetimibe-statin vs statin monotherapy (weighted mean difference [WMD]: -14.1% [-16.1, -12.1], p < 0.001). Reduction in LDL-C levels attributed to add-on ezetimibe was significantly greater than that for statin dose doubling (WMD: -15.3% [-19.1, -11.4], p < 0.001). Achievement of LDL-C goal favoured add-on ezetimibe over statin titration and was statistically significant (odds ratio: LDL-C treatment goal 2.45 [1.95, 3.08], p = 0.007). CONCLUSIONS: Meta-analyses were restricted by the limited number of studies with similar trial design and method of statin titration. Results indicate that add-on ezetimibe is significantly more effective in reducing LDL-C levels than doubling statin dose, enabling more patients to achieve LDL-C goal. |
| | |
Authors:
|
Dimitri P Mikhailidis; Richard W Lawson; Anna-Louise McCormick; Gillian C Sibbring; Andrew M Tershakovec; Glenn M Davies; Kaan Tunceli |
Publication Detail:
|
Type: Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review Date: 2011-04-07 |
Journal Detail:
|
Title: Current medical research and opinion Volume: 27 ISSN: 1473-4877 ISO Abbreviation: Curr Med Res Opin Publication Date: 2011 Jun |
Date Detail:
|
Created Date: 2011-05-17 Completed Date: 2011-09-15 Revised Date: 2011-10-27 |
Medline Journal Info:
|
Nlm Unique ID: 0351014 Medline TA: Curr Med Res Opin Country: England |
Other Details:
|
Languages: eng Pagination: 1191-210 Citation Subset: IM |
Affiliation:
|
Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), University College London (UCL) Medical School, London, UK. mikhailidis@aol.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Anticholesteremic Agents
/
administration & dosage,
therapeutic use* Azetidines / administration & dosage, therapeutic use* Drug Therapy, Combination Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage, therapeutic use* Hypercholesterolemia / drug therapy* |
| Chemical | |
Reg. No./Substance:
|
0/Anticholesteremic Agents; 0/Azetidines; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 163222-33-1/ezetimibe |
| Comments/Corrections | |
Comment In:
|
Curr Med Res Opin. 2011 Oct;27(10):1959-60; author reply 1961
[PMID:
21892853
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Lack of involvement of medical writers and the pharmaceutical industry in publications retracted for...
Next Document: Honokiol inhibits hypoxia-inducible factor-1 pathway.