Ezetimibe May Not Help All ASCVD Patients Reach LDL-C Goal

A total of 1,451 patients with atherosclerotic cardiovascular disease, taking statins, were assessed in this study
A total of 1,451 patients with atherosclerotic cardiovascular disease, taking statins, were assessed in this study

WASHINGTON, DC—For some atherosclerotic cardiovascular disease (ASCVD) patients on statin therapy, the addition of ezetimibe may not provide enough benefit to help these high risk patients reach low-density lipoprotein cholesterol (LDL-C) goals. Findings from this real-world study were presented at the ACC.17 Scientific Session.

To investigate the effectiveness of ezetimibe, a cholesterol absorption inhibitor, researchers from TechData Service Company, King of Prussia, PA, and Sanofi, Bridgewater, NJ, identified a cohort of adult ASCVD patients between January 2007 and June 2015 using the Optum Clinformatics claims database. These patients were all current statin users, had an LDL-C ≥70mg/dL and were starting treatment with ezetimibe. Patients were considered to have reached goal if they achieved an LDL-C level of less than 70mg/dL after 3 months of ezetimibe treatment.

One thousand four hundred and fifty-one patients were included in the study (mean age: 65 years; 56% male; 48% on high-intensity statins). After 3 months of treatment with ezetimibe, 48% of patients with baseline LDL-C between 70mg/dL and 99mg/dL achieved goal; this group saw a 12% reduction in LDL-C. For patients with a baseline LDL-C between 100 and 129mg/dL, 31% of patients achieved goal with a reduction in LDL-C of 21%. Only 10% of patients with baseline LDL-C ≥130mg/dL achieved goal, however they had the largest reduction in LDL-C (-27%). 

Higher baseline LDL-C, no baseline high-intensity statin use, and poor ezetimibe adherence all contributed to smaller LDL-reductions and reduced odds of goal achievement. This pattern of results were also seen for ezetimibe patients in the ODYSSEY trial, observed study authors.

"While we observed largely comparable LDL-C reductions by ezetimibe in real-world ASCVD patients to those from randomized clinical trials, the majority of patients could not achieve a goal of <70mg/dL. For these high CV risk patients, better treatment options with more potent LDL-C reduction may be warranted," Ye Tian, lead author of the study, concluded.