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Pitavastatin superior to pravastatin for LDL reduction
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New data from the PREVAIL US trial suggest that pitavastatin is superior to pravastatin for reducing LDL and improving other lipid parameters, including total cholesterol, triglycerides, apolipoprotein B and non-HDL, researchers said at the National Lipid Association’s Scientific Sessions.
The 12-week, phase 4, multicenter, double blind PREVAIL US trial included 328 patients aged 18 to 80 years with primary hyperlipidemia or mixed dyslipidemia. Researchers randomly assigned participants to once-daily morning doses of pitavastatin 4 mg (Livalo, Kowa Pharmaceuticals and Eli Lilly) or pravastatin 40 mg (Pravachol, Bristol-Myers Squibb). They used nuclear magnetic resonance to assess full lipid panels and lipoprotein particles at day 1 and after the study’s conclusion.
Patients in the pitavastatin group experienced a greater median percent reduction in LDL than those in the pravastatin group (38.1% vs. 26.4%). Pitavastatin was also associated with greater decreases in total cholesterol (25.8% vs. 18.3%) and ApoB (26.9% vs. 17.7%).
Additionally, treatment with pitavastatin resulted in a significantly greater reduction in concentration of LDL particles when compared with pravastatin (517 nmol/L vs. 396 nmol/L; P<.001). Both drugs were associated with increases in HDL particles (9.59% vs. 7.03%; P=.045), but researchers noted significant increases in HDL size and small HDL among patients in the pitavastatin group vs. the pravastatin group. Further, data linked pitavastatin to considerable reductions in very LDL and intermediate-density lipoprotein particles when compared with pravastatin.
Although results indicated improvement in ApoA-I and medium and large HDL with both drugs, there were no statistically significant differences between treatment arms. Additionally, overall incidence of treatment-emergent adverse events did not differ significantly (47.6% for pitavastatin and 44.5% for pravastatin).
“We continue to research and pursue a greater understanding on the effect of lipid-modifying agents, particularly statins, on lipoprotein particles and the use of direct measures of particle number and size in advancing our clinical assessment of dyslipidemia and its treatment,” study researcher Kari Uusinarkaus, MD, fellow of the National Lipid Association and associate medical director of the adult primary care and disease management departments at Colorado Springs Health Partners, said in a press release.