title: Trends in use of ezetimibe after the ENHANCE trial, 2007 through 2010.
abstract: OBJECTIVE
  Results from the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) trial, announced in January 2008, demonstrated that ezetimibe use lowered cholesterol levels but did not slow the progression of atherosclerosis.
  
  
  OBJECTIVE
  To examine the association of this announcement with national patterns of ezetimibe prescribing, including medication initiation and discontinuation, as well as predictors of use.
  
  
  METHODS
  Retrospective analysis of a national sample of adults 18 years or older who were continuously enrolled in plans of a large US pharmacy benefit manager from 2007 to 2010.
  
  
  METHODS
  Lipid-lowering therapy prescription claims were categorized as ezetimibe-containing treatments or any other lipid-lowering agent. Initiation was defined as an ezetimibe claim without another in the prior 180 days; discontinuation, as an ezetimibe claim without another in the subsequent 180 days.
  
  
  RESULTS
  From 2007 to 2010, 29.1% of the 10,597,296 continuously eligible adults obtained at least 1 lipid-lowering agent prescription. Among these adults, 17.8% were prescribed ezetimibe and 95.3% another lipid-lowering agent, predominantly statins. Ezetimibe use peaked in January 2008, when 2.5% of all adults were ezetimibe users, but declined to 1.8% by December 2010. The ENHANCE trial announcement was associated with a nonsignificant 0.16% fewer monthly ezetimibe users (P = .11) but a significant 0.14% more monthly monotherapy users and 0.30% fewer users of ezetimibe concomitant with other lipid-lowering agents (both P = .01). The ENHANCE trial was also associated with 0.44% fewer monthly ezetimibe initiations (P = .002) and 10.4% more monthly ezetimibe discontinuations (P < .001), particularly of ezetimibe monotherapy for both. More than half of adults who initiated ezetimibe use did so without first being prescribed another lipid-lowering agent, both before (50%-60%) and after (60%-70%) the trial. Those aged 50 to 64 years and those living in the East South Central US Census division were both more likely to initiate and less likely to discontinue ezetimibe after the ENHANCE trial.
  
  
  CONCLUSIONS
  After announcement of the results of the ENHANCE trial, nearly 2% of all continuously enrolled adult beneficiaries within a large US pharmacy benefit manager used ezetimibe, although ezetimibe initiations declined and discontinuations increased.
authors: Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut2Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven.
authors: Joseph S
authors: JS
authors: Ross
authors: Division of Research and New Solutions, Express Scripts Inc, St Louis, Missouri.
authors: Sharon G
authors: SG
authors: Frazee
authors: Division of Research and New Solutions, Express Scripts Inc, St Louis, Missouri.
authors: Susan B
authors: SB
authors: Garavaglia
authors: Division of Research and New Solutions, Express Scripts Inc, St Louis, Missouri.
authors: Rebecca
authors: R
authors: Levin
authors: Division of Research and New Solutions, Express Scripts Inc, St Louis, Missouri.
authors: Haik
authors: H
authors: Novshadian
authors: Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Los Angeles, California7Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada.
authors: Cynthia A
authors: CA
authors: Jackevicius
authors: Division of Research and New Solutions, Express Scripts Inc, St Louis, Missouri.
authors: Glen
authors: G
authors: Stettin
authors: Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut3Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale School of Public Hea.
authors: Harlan M
authors: HM
authors: Krumholz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000517:prevention & control; D001384:Azetidines / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy*; D007356:Insurance, Pharmaceutical Services; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019821:Simvastatin / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019821:Simvastatin; D000069438:Ezetimibe