Comparison of clinical effectiveness of ezetymib/simvastatin combination v. atorvastatin and rosuvastatin in achievement the Joint British Societies (JBS)-2 low density-lipoprotein cholesterol (LDL-C) target – UK General Practice Trial (IN-PRACTICE) Review article

Abstract

Aim: The aim of this study was to compare ezetimibe ⁄ simvastatin combination therapy with intensified statin monotherapy (atorvastatin and rosuvastatin) as alternative treatment strategies to achieve the Joint British Societies (JBS)-2 low density-lipoprotein cholesterol (LDL-C) target of <2 mmol/L for primary and secondary prevention in high-risk patients who have failed to reach target with pharamacotherapy with simvastatin 40 mg.

Methods: the IN-PRACTICE study was prospective, double-blind study. 1748 patients with established coronary artery disease (CAD), diabetes or high risk of CAD on at least 6 week duration therapy with simvastatin 40mg were enrolled to this study and 786 (45%) with fasting LDL-C >2,0 mmol/L (and <4,2 mmol/L) after further 6-week run-in period on simvastatin 40 mg were randomised to three groups receiving: ezetimibe⁄simvastatin (10⁄40 mg), atorvastatin (40 mg) or rosuvastatin (5–10 mg). The primary outcome of the study was proportion of study population that achieved LDL-C <2 mmol/L.

Results: The proportion of patients that achieved JBS-2 target was following: 69,4% with ezetimibe⁄simvastatin (10⁄40 mg) v. 33,5% for atorvastatin (40 mg) (p <0,001) and 14,3% for rosuvastatin (5–10 mg) (p <0,001). Authors observed similar results for reducing total cholesterol concentration (<4,0 mmol/L).

Conclusions: combined treatment with ezetimibe⁄simvastatin (10⁄40 mg) appeared to be more effective strategy in lowering LDL-C than intensification of statin monotherapy (atorvastatin 40 mg and rosuvastatin 5–10 mg).