Lipoprotein effects of combined ezetimibe and colesevelam hydrochloride versus ezetimibe alone in hypercholesterolemic subjects: a pilot study

Abstract

Two drug classes act in the intestine to lower cholesterol. Ezetimibe inhibits cholesterol absorption, whereas bile acid–binding resins enhance cholesterol excretion via enhanced conversion to bile acids. Combining these 2 classes may be beneficial, but cholestyramine binds ezetimibe, and the combined effect of colesevelam hydrochloride and ezetimibe was little studied. The aim of the study was to determine if adding colesevelam HCl to ezetimibe provides additional lowering of low-density lipoprotein– and apolipoprotein B–containing lipoproteins or alters ezetimibe levels. Twenty subjects with low-density lipoprotein cholesterol (LDL-C) levels of 130 mg/dL or higher were enrolled and taught a National Cholesterol Education Program Step I diet. At a second baseline visit, lipoproteins were measured and subjects were randomly allocated to (1) ezetimibe 10 mg daily with placebo colesevelam HCl twice daily (E) or (2) ezetimibe 10 mg daily with 1.875 g colesevelam HCl twice daily (E + C). Lipoproteins were measured 6 and 12 weeks after initiating treatment. Baseline characteristics (mean ± SD) were statistically indistinguishable in E vs E + C: LDL-C (mg/dL), 167 ± 26 and 158 ± 27; triglyceride, 134 ± 75 and 140 ± 67; and BMI, 29.4 ± 4.9 and 27.8 ± 6.6 kg/m 2, respectively. Percent changes after 12 weeks in E vs E + C were as follows: LDL-C, −24 ± 12 vs −30 ± 11 ( P = .102); triglyceride, −19 ± 34 vs 36 ± 85 ( P = .054; at 6 weeks, P = .009); total cholesterol, −19 ± 9 vs −15 ± 8 ( P = .50); non–high-density lipoprotein cholesterol, −25 ± 10 vs −21 ± 11 ( P = .70); apolipoprotein B, −31 ± 14 vs −22 ± 14 ( P = .41). Plasma ezetimibe levels at 12 weeks were 21% lower in E + C vs E, a nonsignificant difference ( P = .54). In conclusion, in the short term, colesevelam HCl may not consistently add cholesterol-lowering benefit to ezetimibe. This observation requires confirmation.