Changes in Prescription Patterns for Ezetimibe/Simvastatin, Ezetimibe and Statin, and Statin Therapies and Expected Effects on LDL-C Reduction

Abstract

Synopsis: Recent trends in managed care databases have suggested decreased use of ezetimibe/simvastatin (E/S) combination and coadministered E and statin therapies. Purpose: This analysis evaluated changes in prescription (Rx) patterns for E/S, E and statins, and statin therapies in a managed care database and expected effects on LDL-C lowering during 2007–2008. Methods: Rx pattern changes of two cohorts identified during time periods (July 14, 2007––January 13, 2008 vs January 14, 2008–July 13, 2008; 6-month periods before and after reporting of the ENHANCE trial results on January 14, 2008) who were initially on E/S, E and statins, and statin therapies were assessed by the use of patient level-data from the IMS Longitudinal Rx database. Expected LDL-C reductions were estimated by the use of data from previous controlled clinical trials. Results: During the 6-month period after January 14, 2008 (January 14, 2008–July 13, 2008), more patients were switched from E/S (∼3.6X) and E and statins (∼1.3X) to other lipid-lowering therapies (LLTs) by health-care providers compared with the 6-month period before January 14, 2008 (July 14, 07––January 13, 2008). The number of patients who discontinued these LLTs also increased slightly during the 6-month time period after January 14, 2008. Among patients on E/S, a greater proportion of patients switched to statin monotherapy in the later period. Rx switching patterns were similar for statins during both time periods, although lower numbers of patients were switched to E/S and E and statin therapies in the 6-month period after January 14, 2008. On the basis of previous clinical data with these therapies, smaller LDL-C reductions would be expected in patients who switched from E/S and E and statin therapies to statin monotherapy (∼−54% to −56% vs ∼−42%, respectively). Despite a trend toward switching to greater statin doses in the later time period (eg, from mean doses of E/S 10/33 mg to S 42 mg), significant increases in expected LDL-C levels remained. Conclusions: During January 14, 2008 to July 13, 2008, more patients switched from E/S and E and S therapies to statin monotherapy. In these patients, LDL-C levels would be expected to increase by 10% to 13%. A change of this magnitude will decrease the percentage of patients able to attain their NCEP risk-stratified LDL-C goals. The public health impact of these effects is unknown, and further study is needed. These results indicate that healthcare providers should consider more carefully the impact on lipid levels when changing lipid-lowering regimens.