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Combination Lipid-Lowering Therapy May Not Be More Effective Than High-Dose Statin Monotherapy

"Limited evidence" suggests that combination lipid-lowering therapy is no more effective than high-dose statin monotherapy for improving clinical outcomes, according to a meta-analysis published online in Annals of Internal Medicine.

Researchers examined studies comparing the efficacy of statin monotherapy with combination therapy in high-risk patients. Among the findings:

• In three fair- to poor-quality trials, statin-ezetimibe and statin-fibrate combinations did not improve all-cause mortality relative to high-dose statin monotherapy.
  
• No relevant trials assessed MI, stroke, or revascularization outcomes.
  
• Two fair-quality trials found statin-ezetimibe superior to monotherapy in terms of LDL reductions.
  

The authors point out several limitations of their analysis, including the lack of long-term data. They conclude: "The available evidence supporting the use of combination therapies over high-dose statin monotherapy ... is insufficient to guide many clinical decisions."

LINK(S):

Annals of Internal Medicine article (Free)

Physician's First Watch coverage of study on efficacy of ezetimibe (Free)

Published in Physician's First Watch September 1, 2009

Reader Remarks:

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• ezetimibe-statin vs statin alone
  john l brown, 28 Sep 2009 2:21 PM EST
  While intuitively attractive, the science does not yet support the ezetimibe-statin approach over the statin-only approach. More research is needed.... [more]