title: Systematic literature review and meta-analysis of dual therapy with fenofibrate or fenofibric acid and a statin versus a double or equivalent dose of statin monotherapy.
abstract: OBJECTIVE
  To assess the efficacy of fenofibrate and statin dual therapy versus a double or equivalent dose of statin monotherapy.
  
  
  METHODS
  A systematic literature search and meta-analysis was performed for publications before 1 January 2014 in MEDLINE, Embase, and BIOSIS Previews, among others.
  
  
  RESULTS
  The difference in percentage change from baseline was in favor of dual therapy versus a double dose of statin monotherapy for triglycerides (difference -20%; standard error [SE] 2.6%) and HDL-C (8.7%; SE 1.2%), but not for LDL-C (8.4%; SE 1.5%), non-HDL-C (2.8%; SE 1.1%), total cholesterol (4.5%; SE 1.0%) and apolipoprotein B (2.6%; SE 1.1%). For high intensity statins, the difference in percentage change from baseline was in favor of dual therapy versus equivalent statin monotherapy for triglycerides (-17%; SE 2.6%) and for HDL-C (8.7%; SE 1.9%). The difference in percentage change from baseline for LDL-C was 6% (SE 1.7%), implying a greater reduction in LDL-C with statin monotherapy. For moderate intensity statins, the difference in percentage change from baseline was in favor of dual therapy versus equivalent statin monotherapy for triglycerides (-24.2%; SE 1.2%) and HDL-C (8.2%; SE 0.9%). LDL-C decreased 2.2% (SE 1.4%) more with dual therapy.
  
  
  CONCLUSIONS
  When aiming to change HDL-C or triglycerides, dual therapy is to be preferred to doubling the statin dose; conversely, doubling the statin dose is to be preferred when aiming to reduce LDL-C. If the aim is both to change HDL-C or triglycerides and to reduce LDL-C, the importance of the three outcomes may need to be weighed depending on the intensity of the statin. Combining high intensity statin therapy with fenofibrate improves the effect on HDL-C and triglycerides, but lowers the effect on LDL-C. Combining a moderate intensity statin with fenofibrate improves the effect on HDL-C and triglycerides without reducing the effect on LDL-C. There is a need for long-term randomized clinical trials to compare dual therapy versus doubling the statin dose to assess the importance of improvement in HDL-C and triglycerides versus improvement in LDL-C in terms of cardiovascular outcomes. Further, the addition of ezetimibe to statin/fenofibrate therapy may be of interest.
authors.affiliation: a a Abbott Healthcare Products BV , Weesp , The Netherlands.
authors.forename: Mario J N M
authors.initials: MJ
authors.lastname: Ouwens
authors.affiliation: a a Abbott Healthcare Products BV , Weesp , The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Nauta
authors.affiliation: b b Clinsciences , Dijon , France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Ansquer
authors.affiliation: a a Abbott Healthcare Products BV , Weesp , The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Driessen
mesh_terms: D001055:Apolipoproteins B / Q000097:blood; D002784:Cholesterol / Q000097:blood*; D004359:Drug Therapy, Combination; D011345:Fenofibrate / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D014280:Triglycerides / Q000097:blood
chemical_list: D001055:Apolipoproteins B; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides; D002784:Cholesterol; C006012:fenofibric acid; D011345:Fenofibrate
keywords: Double statin; Dual therapy; HDL-C; Hyperlipidemia; LDL-C; Triglycerides