Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia: systematic review and meta-analysis
Mikhailidis DP, Lawson RW, McCormick AL, Sibbring GC, Tershakovec AM, Davies GM, Tunceli K
Current medical research and opinion · 57 citas
Etiquetas de revisión
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Marcadores de salud y funcionamiento
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2011-04-07 · Curr Med Res Opin · vol. 27 · número 6 · págs. 1191–1210
- Editorial
- Taylor & Francis
- Citado
- 80 citas · más que el 87% de estudios similares · 2.2× el promedio de su campo
- Referencias
- 46 trabajos
- Acceso
- De pago
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cholesterol and Lipid Metabolism · Cancer, Lipids, and Metabolism
- Palabras clave
- ezetimibe, statins, hypercholesterolemia, LDL cholesterol lowering, statin dose titration, combination therapy, simvastatin, atorvastatin, rosuvastatin, lipid-lowering efficacy, statin intolerance, statin safety, statin adverse effects
- MeSH
- humans, hypercholesterolemia, azetidines, anticholesteremic agents, hydroxymethylglutaryl-coa reductase inhibitors, drug therapy, combination, ezetimibe
7 autores
- Dimitri P. Mikhailidis🇬🇧 · autor de correspondenciaUniversity College London
- Richard W. Lawson
- Anna-Louise McCormick
- Gillian C. Sibbring
- Andrew M. Tershakovec🇺🇸Merck & Co., Inc., Rahway, NJ, USA (United States)
- Glenn Davies🇺🇸Merck & Co., Inc., Rahway, NJ, USA (United States)
- Kaan Tunceli🇺🇸Merck & Co., Inc., Rahway, NJ, USA (United States)
Resumen
El texto original del estudio, en el idioma en que se publicó.
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.
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