Medication combo trumps rosuvastatin in cutting LDL

A combination of ezetimibe and simvastatin provides additional lipid-modifying benefits compared with rosuvastatin monotherapy among patients with type 2 diabetes or with metabolic syndrome without diabetes. Overall, ezetimibe/simvastatin, a single-tablet, dual-cholesterol inhibitor, offers an effective and well-tolerated lipid-modifying option for the treatment of hypercholesterolemia in patients with type 2 diabetes, and metabolic syndrome. In a post-hoc analysis of data from a multicenter, double-blind, randomized, six-week study, 375 patients with type 2 diabetes, 840 with metabolic syndrome but without diabetes, 1,722 with neither condition, and 22 who could not be placed in a category because of missing data were randomized to one of six treatment groups: ezetimibe/simvastatin (E/S) in doses of 10 mg/80 mg; or rosuvastatin ® in doses of 10, 20, or 40 mg. All had hypercholesterolemia, defined as an LDL-cholesterol level of 145-249 mg/DI (3.7-6.4)  with triglycerides at or below 350 mg/dL (4 mmol/L).

Among the whole cohort of 2,959 patients, significant reductions in LDL cholesterol from baseline were seen among the E/S group at the usual starting, next highest, and maximum dosing levels. Across all doses, the difference in LDL-cholesterol reduction between E/S and R was significant for the whole cohort (55.8% vs. 51.6%). Consistent with that, LDL-cholesterol lowering was also greater with E/S in the type 2 diabetes patients (58.5% vs. 54.2%).

Overall, 95.3% of the E/S group, compared with 92.1% of the R group, attained the recommended LDL-cholesterol goals of less than 100 mg/dL (2.6 mmol/L) for the diabetics, 130 mg/Dl (3.4 mmol/L) for the nondiabetics with metabolic syndrome, or 160 mg/Dl(4.1 mmol/L) for the group with neither. A total of 88.2% of the E/S patients versus 81.9% of the R patients achieved an LDL-cholesterol level of less than 100 mg/dL (2.6 mmol/L) whereas 45.3% vs. 29.5% reached an LDL cholesterol level of less than 70 mg/dL (1.8mmol/L).

All of these differences were significant. Reductions in total cholesterol, non-HDL cholesterol, apolipo-protein B, and triglycerides were also significantly greater with E/S; there were no significant differences between the two treatments in HDL cholesterol, or high-sensitivity C-reactive protein.

Both drugs showed similar rates of adverse events (8.1% E/S vs. 7.4%R) and discontinuations because of adverse events (2.2% for both drugs). Proteinuria was higher at baseline in the R group and among those with diabetes.