Achieving goal lipid levels with ezetimibe plus statin add-on or switch therapy compared with doubling the statin dose. A pooled analysis

- Many patients on statin monotherapy require additional LDL-C lowering.
- Therapies with greater LDL-C lowering efficacy than statin monotherapy were evaluated.
- Ezetimibe add-on and switching to ezetimibe/simvastatin therapies provided the largest reductions in LDL-C, non-HDL-C, and ApoB.
- Goal attainment rates for these lipids were also highest with ezetimibe add-on and switching to ezetimibe/simvastatin therapies.
- Attainment rates were greatest in patients within 0.8 mmol/L of the lipid targets.

Objective: Evaluate the lipid-altering effects of ezetimibe added to ongoing statin therapy, statin titration, switching from statin monotherapy to a more potent statin or to ezetimibe/simvastatin. Methods: A pooled analysis of patient-level data from 17 double-blind, active or placebo-controlled studies of 8667 hypercholesterolemic adults randomized to ezetimibe 10 mg added to ongoing statins, statin titration (doubling), or switching from ongoing statins to rosuvastatin (10 mg) or to ezetimibe/simvastatin (10/20 and 40 mg). Percent change from baseline in low-density lipoprotein cholesterol (LDL-C) was estimated by analysis of variance. Percent of patients who achieved LDL-C and other guideline-recommended targets, and target lipid levels by baseline distance to goal were evaluated. Results: LDL-C percent change from baseline was −26.0 for ezetimibe added to ongoing statin therapy, −27.6 for switching from ongoing statin to ezetimibe/simvastatin, −19.7 for switching to rosuvastatin 10 mg, and −9.7 for dose doubling of the ongoing statin. For patients within 0.8 mmol/L (30 mg/dL) of the target at baseline, LDL-C target attainment rates were 75.9% for adding ezetimibe to ongoing statin, 72.8% for switching to ezetimibe/simvastatin, 61.8% for switching to rosuvastatin, and 44.3% for statin dose-doubling. Similarly, improvements in other lipids and achievement of non-high-density lipoprotein cholesterol and apolipoprotein B targets among this patient group were largest for ezetimibe added to ongoing statins and switching to ezetimibe/simvastatin; switching to rosuvastatin 10 mg and statin dose-doubling were less effective. Conclusions: Adding ezetimibe to ongoing statin therapy appeared to be an effective option for patients who do not achieve lipid-lowering goals on statins alone.