Is it Time for Single-Pill Combinations in Dyslipidemia?

Schiele, François; Isla, Leopoldo Pérez de; Arca, Marcello; Vlachopoulos, Charalambos

doi:10.1007/s40256-021-00498-2

Cited by 9 publications

(4 citation statements)

References 57 publications

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“…On the other hand, if the increase in ezetimibe monotherapy mainly represented an increase in prescriptions of statins and ezetimibe as separate pills, this would open the opportunity to improve care by enhancing the utilization of FDC. For antihypertensive and lipid-lowering treatment, FDC compared to separate pills lead to improved medication adherence, improved persistence, better control of blood pressure and LDL-C concentrations, respectively ( 7 , 20 ), and are associated with a lower incidence of cardiovascular events and lower all-cause mortality ( 21 ). Improved medication adherence has been associated with favorable outcomes ( 22 – 24 ).…”

Section: Discussionmentioning

confidence: 99%

Trends in Ezetimibe Prescriptions as Monotherapy or Fixed-Dose Combination in Germany 2012–2021

Katzmann

Kieble²,

Enners³

et al. 2022

Front. Cardiovasc. Med.

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AimsAddition of ezetimibe to statin therapy is recommended by current guidelines when low-density lipoprotein cholesterol (LDL-C) targets are not achieved with statin monotherapy. Fixed-dose combinations (FDC) improve medication adherence and facilitate risk factor control. We assessed prescription trends of ezetimibe as monotherapy or FDC with statins.MethodsData from the German Institute for Drug Use Evaluation (DAPI) containing dispensing data of >80% of community pharmacies were analyzed. Prescriptions over time of lipid-lowering agents at the expense of the statutory health insurance (SHI) were extrapolated to all SHI-insured persons, representing approximately 88% of the total German population. Drug utilization was expressed as defined daily doses per 1,000 SHI-insured persons per day (DID).ResultsOf all lipid-lowering drug prescriptions in 2021, 91.2% were statin monotherapy. Ezetimibe was prescribed as monotherapy or FDC with statin in 4.4 and 2.9%, respectively. DID steadily increased for statin (69%) and ezetimibe (424%) monotherapies between 2012 and 2021. In contrast, statin-ezetimibe FDC prescriptions exhibited only a minor increase (29%). The proportion of statin-ezetimibe FDC among all statin prescriptions was stable over time at approximately 3%. FDC prescription rates by specialists were higher compared to general practitioners and varied considerably between geographic areas.ConclusionCombination lipid-lowering therapy is prescribed to a minority of patients. Prescriptions of ezetimibe as monotherapy increased to a much greater extent than statin-ezetimibe FDC. Considering the low proportion of patients achieving their LDL-C target and improved adherence to FDC compared to separate pills, statin-ezetimibe FDC may be utilized to improve the management of dyslipidemia.

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Section: Discussionmentioning

confidence: 99%

Trends in Ezetimibe Prescriptions as Monotherapy or Fixed-Dose Combination in Germany 2012–2021

Katzmann

Kieble²,

Enners³

et al. 2022

Front. Cardiovasc. Med.

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“…Additionally, the combination therapy's safety and tolerability profiles appear to be comparable to those of lowdose statin monotherapies (18). Similarly, evidence from randomized controlled studies conducted on a number of individuals revealed that adding ezetimibe to statins, as opposed to increasing the statin dose, resulted in significantly more patients meeting their LDL-C goals and much fewer patients stopping their medication due to adverse effects (19). Likewise, Zhu et al reported in their findings that ezetimibe and atorvastatin combination therapy significantly reduced LDL-C, non-HDL-C, total cholesterol, and triglycerides levels by 14.16%, 14.01%, 11.06%, and 5.96%, respectively, when compared to double-dose atorvastatin monotherapy (p< 0.001).…”

Section: Evidence From Literaturementioning

confidence: 92%

Role of Ezetimibe and Statins in Dyslipidemia Patients

Alsubhi,

Alshalfan,

Alahmary

et al. 2023

JOHS

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Cardiovascular diseases are the leading cause of premature mortality globally. It is associated with significant morbidity and socioeconomic burden henceforth numerous initiatives have been taken to lower the risk in patients through preventive measures. The pathogenesis and progression of nearly all cardiovascular diseases are primarily caused by atherosclerosis and the association of cardiovascular disease risk to dyslipidemia is well-established since it increases the risk of cardiovascular events. Therefore, managing cholesterol, especially low-density lipoprotein, to reduce the burden of atherosclerotic plaque and, potentially, future cardiac complications, has been a key component of preventive measures. Due to its simplicity in dosage, lack of significant medication interactions, and favourable safety profile, statins have been the gold standard therapy for the treatment of dyslipidemia. However, the need for combined therapy arises when statin medication alone is insufficient to effectively reduce increased cholesterol levels. Ezetimibe is frequently added to regimens to support cholesterol reduction by preventing cholesterol absorption. Combinations of statin and ezetimibe may be a beneficial treatment choice for high-risk individuals who necessitate further lowering of cholesterol. Studies in the literature demonstrate that statin plus ezetimibe combined therapy is more beneficial and safer than high-intensity statin monotherapy, which implies that adding ezetimibe to statin should be favoured over increasing statin dose and that high-intensity statin is needed to be administered more carefully, especially in patients with related risks. The purpose of this research is to review the role of ezetimibe and statins in dyslipidemia patients.

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“…There is interest in the role of fixed-dose combination treatment in the management of hypertension 35 and hyperlipidaemia. 36 In the management of newly diagnosed hypertension, there is evidence that commencing 2 drugs, either individually or as a fixed-dose combination, is associated with reduced therapeutic inertia. A large Italian observational study of patients who started antihypertensive treatment with one drug or a combination of 2 drugs found that the majority of patients prescribed monotherapy did not progress to combination treatment in accordance with guidelines.…”

Section: Addressing Therapeutic Inertiamentioning

confidence: 99%

Therapeutic inertia

Usherwood

2024

Aust Prescr

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Summary Therapeutic inertia, sometimes referred to as clinical inertia, has been defined as failure to initiate or intensify therapy when therapeutic goals are not reached. Lack of initiation or intensification of treatment according to clinical guidelines has been linked to suboptimal control of a range of chronic conditions. Clinician factors contributing to therapeutic inertia include knowledge gaps; discomfort with uncertainty about the diagnosis, therapeutic target, or evidence; concerns about the safety of treatment intensification; and time constraints. Patient characteristics that may be associated with therapeutic inertia include male sex, older age, lower life expectancy, multiple comorbidities and clinical parameters that are close to target. There may be reasons other than therapeutic inertia that explain apparent undertreatment. Apparent inertia in prescribing may be accompanied by appropriate actions, such as provision of lifestyle advice or interventions to promote adherence to existing medication. Some patients choose not to intensify treatment. Interventions to reduce therapeutic inertia include access to evidence-based treatment guidelines and point-of-care tools, preferably integrated with clinical record systems; clinician education including educational visits; reminders; clinical audits with feedback and reflection on practice; shared decision-making; prompting by patients; and ambulatory or home monitoring (e.g. ambulatory blood pressure monitoring).

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Is it Time for Single-Pill Combinations in Dyslipidemia?

Cited by 9 publications

References 57 publications

Trends in Ezetimibe Prescriptions as Monotherapy or Fixed-Dose Combination in Germany 2012–2021

Trends in Ezetimibe Prescriptions as Monotherapy or Fixed-Dose Combination in Germany 2012–2021

Role of Ezetimibe and Statins in Dyslipidemia Patients

Therapeutic inertia

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