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Concern over growing use of ezetimibe by GPs

By Nigel Praities

There is ‘no sound basis' for the growing use of lipid-lowering drug ezetimibe within the NHS, according to independent prescribing advisers.

Their editorial in the latest edition of Drugs and Therapeutics Bulletin says the 88% increase in prescribing of ezetimibe since 2004 has proved ‘increasingly expensive' and prescribers should think twice before giving it to patients.

The controversial drug was approved by NICE in 2007 for use if statin monotherapy fails to get patients to their cholesterol goal, despite a lack of data on whether ezetimibe improves cardiovascular mortality or morbidity,

It has been extensively prescribed in the NHS, with around £73.5 million spent on ezetimibe last year and £10m on the statin-ezetimibe combination tablet – compared with just £10m in 2004.

Experts say this is largely due to generic statin prescribing targets blocking GPs from giving patients more potent statins.

The DTB editorial publsihed today says: ‘There is no sound basis for the growing use of ezetimibe.'

‘Ezetimibe is neither of similar efficacy nor similar acquisition cost to simvastatin 80mg daily. So it is questionable whether adding ezetimibe to simvastatin is a cost-effective or outcome-based intervention.'

‘Since it is proving increasingly expensive for the NHS, prescribers should ask why they are using the drug.'

Dr Rubin Minhas, clinical director at the BMJ Evidence Centre and a GP in Kent, said: ‘GP concern over statin side effects and overly aggressive cholesterol targets have spurred increased ezetimibe prescribing.'

‘Ezetimibe should be used sparingly and after alternative statins have been tried.'

A spokesperson from the manufacturer Merck said ezetimibe was one of a number of therapeutic options available for GPs after initial statin therapy.

‘Depending on the requirements of the patient and the doctor's clinical assessment, having a choice of treatment can be an important and beneficial component of successful lipid management,' he said.

The editorial expressed concern over the growing use of ezetimibe by GPs The editorial expressed concern over the growing use of ezetimibe by GPs