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Cholesterol drug cleared by NICE

Ezetimibe - the cholesterol absorption inhibitor- has been cleared for NHS use by NICE.

But the institute has stopped short of sanctioning the combined ezetimibe-simvastatin treatment, Inegy, which is more expensive than the individual drugs

Ezetimibe monotherapy is recommended when statins are contra-indicated or if patients are intolerant of statins.

NICE studied published evidence and found that a combination of ezetimibe and a statin reduced LDL cholesterol levels by 23.2 per cent compared to statin therapy alone in trials lasting six-eight weeks. Ezetimibe has also proved successful in longer term trials, NICE said.

The ruling will pressure PCTs to fund a treatment that some have previously avoided, said Dr Stewart Findlay, treasurer of the Primary Care Cardiovascular Society and a GP in Bishops Auckland, County Durham.

He added: ‘I think some GPs have been discouraged from using it because of the cost.'

He believes the drug is effective with few side effects.

‘We have seen a dramatic reduction in cholesterol levels as a result,' he said.

‘It has been good for patients that you cannot control with just a statin.'

He added that PCTs and practice based commissioners would now have to look to increase their prescribing budgets to account for in-creased use of ezetimibe.

Dr Gerald Partridge, a GP from Keighley, Yorkshire, with a special interest in cardiology, said: ‘It is a useful drug. Some people cannot tolerate statins at any price and it is one of few drugs that can help such people.'

He said GPs could save money by prescribing statins and ezetimibe separately rather than the all-in-one treatment, which is more expensive.

Michael Livingstone, director of the charity HEART UK cholesterol charity said: ‘We are delighted with the outcome of this appraisal. Increased prescribing of ezetimibe…will be of enormous benefit in preventing premature deaths caused by high cholesterol and coronary heart disease.'

But some GPs have expressed concerns about the higher cost of adding in ezetimibe rather switching to a more powerful statin.

Dr George Kassianos, a GP in Bracknell with a special interest in cardiology, pointed out that a month's course of ezetimibe is around £26 plus £3.80 for 40mg simvastatin compared to £18 for rosuvastatin 10mg said.

Dr Stewart Findlay - ruling will pressurise PCTs to fund the treatment Dr Stewart Findlay - ruling will pressurise PCTs to fund the treatment NICE guidance on ezetimibe NICE guidance on ezetimibe

Ezetimibe co-administered with initial statin therapy is recommended for adults when:
- total cholesterol or low-density lipoprotein is not appropriately controlled AND
- when consideration is being given to changing from initial statin therapy to an alternative statin

Ezetimibe monotherapy is recommended for:
- adults not indicated on statin therapy because of contraindications OR
- adults who are intolerant to statin therapy

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