The truth behind evidence supporting efficacy of Ezetimibe

The latest JAMA Medical News and Perspectives article looks at ezetimibe, approved by FDA in 2002 based on its ability to reduce LDL-C levels (a surrogate marker for prevention of cardiovascular disease) but without assessing clinical outcomes such as incidence of myocardial infarction, stroke or death. The 2008 ENHANCE trial from New England Journal of Medicine showed that addition of ezetimibe did not reduce atherosclerosis progression compared with simvastatin alone, despite lowering LDL-C levels. The latest cholesterol management guidelines, issued late last year by the American College of Cardiology and the American Heart Association, have moved away from reaching a target level for LDL-C. Similarly, future guidelines may abandon the use of ezetimibe and simply “treating the number”. How often do you see patients with ezetimibe prescriptions? What would you recommend or counsel them after learning this?

For additional information, please see the article in JAMA Current Issue.
Click on the link for the study in NEJM.

Image courtesy of [Stuart Miles]/FreeDigitalPhotos.Net

FDA approves combination cholesterol lowering medication

The new combination medication sold under the brand name Liptruzet combines ezetimibe (Zetia) and atorvastatin (Lipitor).  It will be available in four doses, combining 10 milligrams of Zetia with either 10, 20, 40 or 80mg of atorvastatin.  Merck is the maker of Vytorin (a combination of Zetia and simvastatin (Zocor), which is undergoing a long-term study evaluating whether it reduces heart attacks and strokes better than simvastatin alone.

What impact do new cholesterol medications make on your patients?  Do they ask your advice regarding a switch if their cholesterol is not well controlled?

For more information, please see the article in Reuters.

“Image courtesy of Stuart Miles/FreeDigitalPhotos.net.”