Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia : systematic review and meta-analysis
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.
| Errataetall: |
CommentIn: Curr Med Res Opin. 2011 Oct;27(10):1959-60; author reply 1961. - PMID 21892853 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2011 |
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| Erschienen: |
2011 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
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| Enthalten in: |
Current medical research and opinion - 27(2011), 6 vom: 01. Juni, Seite 1191-210 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mikhailidis, Dimitri P [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 15.09.2011 Date Revised 17.03.2022 published: Print-Electronic CommentIn: Curr Med Res Opin. 2011 Oct;27(10):1959-60; author reply 1961. - PMID 21892853 Citation Status MEDLINE |
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| doi: |
10.1185/03007995.2011.571239 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM207290431 |
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| 100 | 1 | |a Mikhailidis, Dimitri P |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia |b systematic review and meta-analysis |
| 264 | 1 | |c 2011 | |
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| 500 | |a Date Completed 15.09.2011 | ||
| 500 | |a Date Revised 17.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Curr Med Res Opin. 2011 Oct;27(10):1959-60; author reply 1961. - PMID 21892853 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Systematic Review | |
| 650 | 7 | |a Anticholesteremic Agents |2 NLM | |
| 650 | 7 | |a Azetidines |2 NLM | |
| 650 | 7 | |a Hydroxymethylglutaryl-CoA Reductase Inhibitors |2 NLM | |
| 650 | 7 | |a Ezetimibe |2 NLM | |
| 650 | 7 | |a EOR26LQQ24 |2 NLM | |
| 700 | 1 | |a Lawson, Richard W |e verfasserin |4 aut | |
| 700 | 1 | |a McCormick, Anna-Louise |e verfasserin |4 aut | |
| 700 | 1 | |a Sibbring, Gillian C |e verfasserin |4 aut | |
| 700 | 1 | |a Tershakovec, Andrew M |e verfasserin |4 aut | |
| 700 | 1 | |a Davies, Glenn M |e verfasserin |4 aut | |
| 700 | 1 | |a Tunceli, Kaan |e verfasserin |4 aut | |
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