A Comparison of Ezetimibe and Evolocumab for Atherogenic Lipid Reduction in Four Patient Populations: A Pooled Efficacy and Safety Analysis of Three Phase 3 Studies

A Comparison of Ezetimibe and Evolocumab for Atherogenic Lipid Reduction in Four Patient Populations: A Pooled Efficacy and Safety Analysis of Three Phase 3 Studies

Introduction Clinicians, payers, guideline committees, and policymakers support the use of high-intensity statins in patients at high risk for complications of cardiovascular disease (CVD). Guidelines and recommendations provide guidance on next steps for patients with inadequate low-density lipopro...

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Bibliographic Details
Published in:Cardiology and Therapy 2020-12, Vol.9 (2), p.447-465
Main Authors: Koren, Michael J., Jones, Peter H., Robinson, Jennifer G., Sullivan, David, Cho, Leslie, Hucko, Thomas, Lopez, J. Antonio G., Fleishman, Alex N., Somaratne, Ransi, Stroes, Erik
Format: Article
Language:eng
Subjects:
Cardiology
Drug therapy
Dyslipidemia
Evolocumab
Ezetimibe
Hypercholesterolemia
Internal Medicine
Lipid-lowering therapy
Medicine
Medicine & Public Health
Original Research
Patient outcomes
PCSK9 inhibition
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Summary:Introduction Clinicians, payers, guideline committees, and policymakers support the use of high-intensity statins in patients at high risk for complications of cardiovascular disease (CVD). Guidelines and recommendations provide guidance on next steps for patients with inadequate low-density lipoprotein cholesterol (LDL-C) control on maximally tolerated statin or for those who are statin-intolerant. Ezetimibe and evolocumab improve CV outcomes when added to statins in high-CV-risk populations. The aim of the study was to compare evolocumab and ezetimibe for lipid-lowering efficacy and safety. Methods We summarized data from 1427 patients from three phase 3 evolocumab studies comparing double-blinded evolocumab vs. ezetimibe. These studies evaluated four distinct populations: those free of CVD receiving each agent as monotherapy, patients with CVD receiving add-on therapy to low- or high-intensity statin, and statin-intolerant patients. Lipid efficacy and safety were reported at week 12. Results Across the studies, evolocumab reduced LDL-C by a mean 55–61% from baseline to week 12; ezetimibe lowered LDL-C by 18–20% from baseline (mean difference = 38–43% favoring evolocumab; p  
ISSN:2193-8261
2193-6544