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Increased ezetimibe dose improves total, LDL cholesterol
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A 20-mg daily dose of ezetimibe yielded significantly greater reductions in total and LDL cholesterol among statin recipients compared with a 10-mg dose, according to results from a recent study.
Researchers performed a retrospective cart review of 27 patients with dyslipidemia who received 10 mg ezetimibe (Zetia, Merck) daily, followed by 20 mg ezetimibe daily, for a duration of 3 months or longer for each regimen. The cohort included 15 patients receiving stable statin therapy and 12 statin nonrecipients. All participants were considered at high risk for CVD.
Statin recipients who received 20-mg ezetimibe experienced significantly greater reductions in total and LDL cholesterol compared with the 10-mg regimen, with additional mean decreases of 7.1% for total cholesterol and 10.3% of LDL while on the 20-g dose (P<.05 for both). Two patients achieved target LDL levels on the 20-mg regimen, compared with zero patients on the 10-mg regimen. Cholesterol reduction among statin nonrecipients did not differ according to ezetimibe dosage.
Researchers also measured plasma concentration of ezetimibe and ezetimibe glucoronide in 13 of the 20 mg ezetimibe recipients and a separate group of 26 10-mg ezetimibe recipients. Patients in the 20-mg group had higher concentrations of ezetimibe (9.11 ng/mL vs. 4.38 ng/mL; P=.0019), total ezetimibe (180.5 ng/mL vs. 78.3 ng/mL; P=.0055) and ezetimibe glucoronide (171.4 ng/mL vs. 7.9 ng/mL; P=.0058).
“This retrospective chart review study demonstrated that, in patients receiving stable statin therapy, ezetimibe 20 mg provided a modest additional mean reduction in total and LDL cholesterol levels compared with ezetimibe 10 mg,” the researchers concluded. “…Increasing the ezetimibe dose to 20 m daily might be an interesting potential approach for patients who fail to reach lipid targets on ezetimibe 10 mg daily along with maximally tolerated doses of statin.”
Disclosure: Researcher Robert A. Hegele, MD, reports serving on advisory boards and speaker’s bureaus for Amgen, Merck and Valeant Pharmaceuticals.
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