Adding ezetimibe to simvastatin is 'more effective' than raised dosage

Adding ezetimibe to simvastatin therapy is more effective than increasing dosage above 20mg, an Italian study has found.

Simvastatin: combined therapy (Photograph: SPL)
Simvastatin: combined therapy (Photograph: SPL)

Dr Gianluca Bardini and colleagues from the University of Florence studied 93 patients who had LDL cholesterol levels of 2.6-4.1 mmol/L and who were taking a stable dosage of simvastatin 20mg.

Patients were randomised to receive either simvastatin 40mg or simvastatin 20mg plus ezetimibe 10mg for six weeks. They were assessed for changes in levels of LDL and HDL cholesterol and triglycerides.

The researchers found that simvastatin plus ezetimibe led to a 32 per cent fall in LDL cholesterol, compared with a 21 per cent fall in patients given simvastatin 40mg.

Simvastatin plus ezetimibe also led to a greater fall in total cholesterol, but changes in HDL cholesterol were similar across the two groups.

'The results of this study demonstrate that co-administration of ezetimibe with simvastatin 20mg may provide a superior alternative for LDL cholesterol lowering compared with doubling the dosage of simvastatin to 40mg in hyperlipidaemic patients with type-2 diabetes and CHD,' the researchers said.

'The combination therapy was generally well tolerated, providing an alternative treatment for patients who require further LDL-C reduction than with simvastatin 20mg alone.'

The incidence of serious adverse events in the study was low. But Dr Bardini and colleagues said the study was relatively small and not powered to assess incidence of rare adverse events.

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