Efficacy and Tolerability of non-daily Statin Administration: A Systematic Review of Literature

Abstract

Current issues regarding biosimilar drug use are reviewed in a two-part article from the perspective of pharmacy practice. Background Statins are known to be safe, but some patients discontinue the therapy due to adverse effects. Given the clinical benefits of statin therapy, it is important to find different strategies to maintain its use. The aims of this systematic review were to summarize and critically appraise evidence of the efficacy, tolerability, and economic evaluation of non-daily statin administration in the past ten years. Methods Literature was searched through Cochrane, Embase, PubMed and Web of Science using relevant search terms. Studies of any size and design published between January 2007 and August 2017 were considered for the assessment of efficacy and tolerability. For economic evaluation, the search was repeated without restriction to the publication year to identify more relevant articles. Results All eleven studies, of which three were randomized controlled trials, supported the use of intermittent statin regimens to lower low-density lipoprotein (LDL) levels in patients with dyslipidemia. Most of the studies reported high tolerability to intermittent statin therapy, ranging from 72.5% to 100%. Economic analysis of four articles showed that the intermittent regimen is cost-saving in terms of cost per 1% LDL reduction. Conclusion Our systematic review of current evidence suggests that patients with dyslipidemia may reduce their LDL levels with intermittent statin administration. Non-daily administration has other benefits of improved tolerability and lower cost when compared to daily administration.

Intolerance upon statin rechallenge: A systematic review and meta-analysis of randomized controlled trials

“…Our findings suggest many individuals believed to be statin intolerant can successfully resume a statin when the expectation of adverse effects is lessened, as is the case with blinding and the possibility of placebo. Although an n-of-1 placebo-controlled trial may not be practical in the clinic, prescribers might achieve similar success by switching statins and using lower doses or alternate daily dosing [ 19 , 20 ]. In addition, n-of-1 unblinded trials in clinic may be effective if prescribers provide reasonable expectation and counselling [ 21 ].…”

Commando care for individuals living with severe mental illness: Equally Well goes beyond metabolic health alone

“…There is evidence, for example, that taking antihypertensive therapy intermittently is not beneficial and that, rather, it may be harmful (Burnier, 2006). In contrast, while not optimal, intermittent adherence to statins is of some benefit (Park and Le, 2019). Finally, diagnostic overshadowing is a documented problem for individuals with mental illness, and this model ensures that care is delivered beyond mental health needs alone.…”