Statin plus ezetimibe treatment in clinical practice: the SI-SPECT (Slovenia (SI) Statin Plus Ezetimibe in Cholesterol Treatment) monitoring of clinical practice study.
BACKGROUND
Poor results from lipid-lowering therapy are mainly due to inadequate dosing and increased adverse effects with high-dose statin monotherapy or drug combinations.


OBJECTIVE
The SI-SPECT (Slovenia (SI) Statin Plus Ezetimibe in Cholesterol Treatment) study evaluated the effectiveness of either ezetimibe (EZE) 10 mg as monotherapy or co-administered with on-going statin treatment (S + EZE) in clinical practice.


METHODS
A total of 1053 dyslipidaemic patients (52% men, age 60.3 years, 42.9% with CHD, 32.0% with diabetes mellitus and 69.6% with hypertension) were enrolled. The majority (n=986; 93.6%) were treated with EZE as 'add-on' to their already prescribed statin, the rest only received EZE (n=67).


METHODS
Baseline lipid levels were compared with those obtained 16 weeks after initiating treatment.


RESULTS
Total (TC) and low density lipoprotein cholesterol (LDL-C), as well as triglycerides (TG) decreased significantly with S + EZE (by 25.3%, 31.4% and 28.9%, respectively; p<0.0001 for all comparisons), while monotherapy with EZE resulted in a decrease of 20.8% for TC (p<0.0001), 28.0% for LDL-C (p<0.0001) and 28.8% for TG (p=0.016). At the end of the study 43.9% of patients achieved target TC (<5.0 mmol/L for primary prevention and <4.5 mmol/L for secondary prevention), 50.5% target LDL-C (<3.0 mmol/L for primary prevention and <2.5 mmol/L for secondary prevention) and 61.6% target TG (<2.0 mmol/L). The overall incidence of adverse effects during the treatment period, and probably related to EZE use, was low (n=6, 0.6% of patients).


CONCLUSIONS
(1) S + EZE combination therapy was effective and safe irrespective of the statin used, (2) the S + EZE combination resulted in significantly more patients reaching their recommended target lipid levels and (3) the lipid-lowering efficacy of EZE in monotherapy as well as of the S + EZE combination was related to initial lipid values. The much greater decrease of TG than expected could be, at least in part, due to better control/compliance regarding diet and drug treatment during the study and adherence to the need for an overnight fast before sampling.
Fras
Zlatko
Z
Department for Vascular Medicine, Division for Internal Medicine, University Medical Centre, Ljubljana, Slovenia. zlatko.fras@siol.net
Mikhailidis
Dimitri P
DP
D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001384:Azetidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic
D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe