title: Successful conversion of patients with hypercholesterolemia from a brand name to a generic cholesterol-lowering drug.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of a simvastatin-to-lovastatin therapeutic conversion program.
  
  
  METHODS
  Observational database study of a therapeutic conversion in members of the Northern and Southern California regions of Kaiser Permanente, using a pretest/posttest design.
  
  
  METHODS
  All patients actively converted from simvastatin to lovastatin between April 1, 2002, and March 31, 2003, were identified for inclusion in the analysis. The conversion from simvastatin to lovastatin was based on an equipotent dose ratio of 1 mg of simvastatin to 2 mg of lovastatin. Electronic prescription record and laboratory data were collected for converted patients beginning 365 days before changing therapy through June 30, 2003. The primary effectiveness end point was a comparison of the preconversion and postconversion low-density lipoprotein cholesterol (LDL-C) levels. Safety end points included an analysis of preconversion and postconversion alanine aminotransferase (ALT) tests and creatine kinase values.
  
  
  RESULTS
  A total of 33,318 converted patients met criteria for inclusion in the analysis. The mean LDL-C was lowered from 110.9 to 108.4 mg/dL (P < .001) following the conversion to lovastatin. The percentage of patients with serum ALT levels greater than 3 times the upper limit of normal (ULN) was similar before (0.7%) and after (0.6%) conversion from simvastatin to lovastatin. Creatine kinase elevations greater then 10 times the ULN occurred at similar rates before and after the conversion.
  
  
  CONCLUSIONS
  Overall, patients had an improvement in their lipid profile without evidence of hepatic or muscle enzyme elevations. Appropriately selected patients can be safely and effectively converted from simvastatin to lovastatin.
authors.affiliation: Pharmacy Analytic Service, Kaiser Permanente Southern California, Downey, California 90242, USA. craig.t.cheetham@kp.org
authors.forename: T Craig
authors.initials: TC
authors.lastname: Cheetham
authors.forename: James
authors.initials: J
authors.lastname: Chan
authors.forename: Victor
authors.initials: V
authors.lastname: Benson
authors.forename: Cathlene
authors.initials: C
authors.lastname: Richmond
authors.forename: Eleanor
authors.initials: E
authors.lastname: Levin
authors.forename: David
authors.initials: D
authors.lastname: Campen
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002140:California; D011307:Drug Prescriptions; D016568:Drugs, Generic / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008148:Lovastatin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D019821:Simvastatin / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D016568:Drugs, Generic; D008148:Lovastatin; D019821:Simvastatin