title: Achieving goal lipid levels with ezetimibe plus statin add-on or switch therapy compared with doubling the statin dose. A pooled analysis.
abstract: OBJECTIVE
  Evaluate the lipid-altering effects of ezetimibe added to ongoing statin therapy, statin titration, switching from statin monotherapy to a more potent statin or to ezetimibe/simvastatin.
  
  
  METHODS
  A pooled analysis of patient-level data from 17 double-blind, active or placebo-controlled studies of 8667 hypercholesterolemic adults randomized to ezetimibe 10 mg added to ongoing statins, statin titration (doubling), or switching from ongoing statins to rosuvastatin (10 mg) or to ezetimibe/simvastatin (10/20 and 40 mg). Percent change from baseline in low-density lipoprotein cholesterol (LDL-C) was estimated by analysis of variance. Percent of patients who achieved LDL-C and other guideline-recommended targets, and target lipid levels by baseline distance to goal were evaluated.
  
  
  RESULTS
  LDL-C percent change from baseline was -26.0 for ezetimibe added to ongoing statin therapy, -27.6 for switching from ongoing statin to ezetimibe/simvastatin, -19.7 for switching to rosuvastatin 10 mg, and -9.7 for dose doubling of the ongoing statin. For patients within 0.8 mmol/L (30 mg/dL) of the target at baseline, LDL-C target attainment rates were 75.9% for adding ezetimibe to ongoing statin, 72.8% for switching to ezetimibe/simvastatin, 61.8% for switching to rosuvastatin, and 44.3% for statin dose-doubling. Similarly, improvements in other lipids and achievement of non-high-density lipoprotein cholesterol and apolipoprotein B targets among this patient group were largest for ezetimibe added to ongoing statins and switching to ezetimibe/simvastatin; switching to rosuvastatin 10 mg and statin dose-doubling were less effective.
  
  
  CONCLUSIONS
  Adding ezetimibe to ongoing statin therapy appeared to be an effective option for patients who do not achieve lipid-lowering goals on statins alone.
authors.affiliation: Merck & Co., Inc., One Merck Drive, Whitehouse Station, NJ 07090, USA. Electronic address: baishali_ambegaonkar@merck.com.
authors.forename: Baishali M
authors.initials: BM
authors.lastname: Ambegaonkar
authors.affiliation: Merck & Co., Inc., One Merck Drive, Whitehouse Station, NJ 07090, USA. Electronic address: dtipping@tippingllc.com.
authors.forename: Diane
authors.initials: D
authors.lastname: Tipping
authors.affiliation: Merck & Co., Inc., One Merck Drive, Whitehouse Station, NJ 07090, USA. Electronic address: adam_polis@merck.com.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Polis
authors.affiliation: Merck & Co., Inc., One Merck Drive, Whitehouse Station, NJ 07090, USA. Electronic address: joanne_tomassini@merck.com.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Tomassini
authors.affiliation: Merck & Co., Inc., One Merck Drive, Whitehouse Station, NJ 07090, USA. Electronic address: andrew_tershakovec@merck.com.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tershakovec
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D001055:Apolipoproteins B / Q000097:blood; D001384:Azetidines / Q000008:administration & dosage*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D000069438:Ezetimibe; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D000068718:Rosuvastatin Calcium; D019821:Simvastatin / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000924:Anticholesteremic Agents; D001055:Apolipoproteins B; D001384:Azetidines; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D019821:Simvastatin; D000069438:Ezetimibe
keywords: Cholesterol; Ezetimibe; Hypercholesterolemia; LDL-C; Lipids; Lipoprotein; Statin