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Further doubts over ezetimibe

By Nigel Praities

More uncertainty has been cast on the use of the cholesterol-lowering drug ezetimibe, after a trial showed adding the drug to statin treatment made little difference to outcomes.

The new data adds to mounting evidence against ezetimibe, with the ENHANCE trial published last year showing no difference in sub-clinical atherosclerosis when ezetimibe was added to statin treatment.

The association between ezetimibe and new-onset cancer found in the SEAS study created a storm last year, with an investigation subsequently launched by the US drugs regulator.

The SANDS trial looked at aggressive LDL-C lowering in patients with Type 2 diabetes, and compared those on statins alone with those who had ezetimibe added to their regimen to give them a further boost to get them to their cholesterol goal.

NICE currently recommends the use of ezetimibe as an adjunct treatment for patients who do not reach their LDL goals on statins alone, but this study casts doubt on this guidance as there was a ‘nearly identical' effect on LDL-C levels and sub-clinical atherosclerosis in both statin and statin-ezetimibe treated groups.

‘Whether addition of ezetimibe to aggressive statin therapy will translate into lower CV event rates in populations without prior CV events must await the results of ongoing trials.

‘In the interim, ezetimibe remains a viable therapeutic option for patients who fail to reach their LDL-C target on a statin alone,' the authors concluded.

The SANDS study was published early online in the Journal of the American College of Cardiology.

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