Patients with Muscle-Related Statin Intolerance May Have Additional Options

Researchers explore possible options for lowering low-density lipoprotein cholesterol.

Many patients receive statin treatment to lower their low-density lipoprotein cholesterol (LDL-C). About 5 to 20% of these patients experience muscle-related side effects from taking the drug.

In these patients, small or intermittent doses of statin or ezetimibe are given instead.

In a study presented at the American College of Cardiology’s 65th Annual Scientific Session & Expo, scientists explored the efficacy of alternate treatment options.

Researchers conducted a randomized clinical trial that enrolled 511 adults who were not currently on medication to control their LDL-C levels and have had statin intolerance in the past.

The first phase of this trial lasted for 24 weeks. Patients were randomly administered atorvastatin or a placebo. Researchers found that 43% of the patients taking atorvastatin discontinued use due to muscle symptoms.

Similar symptoms were reported by 27% of patients in the placebo group as well.

In the second phase of the trial, patients were randomly given evolocumab or oral ezetimibe.

Researchers found that patients who administered ezetimibe experienced a 17% reduction in their LDL-C levels. Patients who were assigned evolocumb experienced a 50% reduction in LDL-C levels.

In 30% of evolocumab-treated patients and 1.4% of ezetimibe-treated patients, the goal of less than 70 mg/dl was met.

“These findings demonstrate that both drugs are unlikely to provoke muscle symptoms and can be administered successfully in such patients, although with significant differences in lipid-lowering efficacy,” Steven E. Nissen, MD stated in a press release. “Since a minority of patients achieved optimal LDL-C levels despite treatment with evolocumab, it may be worth exploring the addition of ezetimibe to evolocumab for those patients requiring further LDL-C reduction. It should be noted that neither ezetimibe nor evolocumab is approved for reduction of major adverse cardiovascular events.”