The need for a systematic approach to statin switching: an analysis of real-world experience.
BACKGROUND
In the advent of generic statins becoming increasingly available and with the recent addition of atorvastatin to the generic market, healthcare providers are often encouraged by payers to switch from a branded statin to an alternate, less costly agent.


OBJECTIVE
The aim of this study was to determine the impact of a therapeutic switch on cholesterol goal attainment among patients with existing cardiovascular disease (CVD) or risk factors for CVD.


METHODS
A cross-sectional, multisite retrospective review of patient records evaluating low-density lipoprotein cholesterol (LDL-C) control before and after switching statins was conducted.


METHODS
Participants were 18 to 89 years olds who were stable on statin therapy and had 1 or more risk factors for CVD. Patients meeting switch criteria (n = 833) were evaluated for changes in their statin therapy and LDL-C goal attainment. Drug/dose information, cholesterol values, and goal attainment in accordance with National Cholesterol Education Panel Third Adult Treatment Panel guidelines were determined before and after the switch. Dose potency was based on mean LDL-C reductions.


RESULTS
Data were collected from 22 US sites. Risk factors for CVD were common, with 88.5% of patients identified as high risk. Overall, patients' mean LDL-C levels improved from 87.1 to 81.5 mg/dL, and goal attainment increased from 75.5% to 82.5% (P < .05). Switches to a comparable or higher statin/dose improved mean LDL-C and goal attainment (P < .05). However, in patients transitioned to a lower statin/dose equivalency (36.4%), mean LDL-C level increased from 79.8 to 85.6 mg/dL and goal attainment fell from 84.2% to 78.6% (P < .05). Logistic regression confirmed that LDL-C goal attainment was reduced by 53% in patients switched to a lower statin/dose (odds ratio, 0.47; 95% confidence interval, 0.30-0.76; P = .002) compared with patients switched to an equipotent dose. The use of adjunctive lipid-lowering therapies increased in patients switched to a lower statin/dose (P < .05).


CONCLUSIONS
Cholesterol values and goal attainment can be negatively impacted when a systematic approach is not used and patients are switched to lower potency therapies.
Peter W. Kakavas, MDDirector of the Echocardiographic and Vascular Laboratories and Cholesterol Modification Program, Heart Care Centers of Illinois, Mokena, and Assistant Professor of Medicine, Rush Medical Center, Chicago. Judy Ly McManus, PharmD Department of Medical Affairs, Medical Outcomes Specialists, Pfizer, Inc, New York. Thomas A. Wolfe, PharmD Department of Medical Affairs, Medical Outcomes Specialists, Pfizer, Inc, New York. Thomas Guidry, PharmD Department of Medical Affairs, Medical Outcomes Specialists, Pfizer, Inc, New York. Daniel N. Flores, PharmD Department of Medical Affairs, Medical Outcomes Specialists, Pfizer, Inc, New York. Linh B. ter Riet, PharmD Department of Medical Affairs, Medical Outcomes Specialists, Pfizer, Inc, New York. Jon J. Glover, PharmD Department of Medical Affairs, Medical Outcomes Specialists, Pfizer, Inc, New York. Heather Sell, PharmD Department of Medical Affairs, Medical Outcomes Specialists, Pfizer, Inc, New York.
Peter W
PW
Kakavas
Judy Ly
JL
McManus
Thomas A
TA
Wolfe
Thomas
T
Guidry
Daniel N
DN
Flores
Linh B
LB
Ter Riet
Jon J
JJ
Glover
Heather
H
Sell
D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D057915:Drug Substitution / Q000592:standards*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors