Internal Medicine News - Zetia
(ezetimibe, Merck and Schering-Plough)
A cholesterol absorption inhibitor for use as an adjunct to diet for reducing elevated total cholesterol, LDL cholesterol, and apo B levels in patients with primary (heterozygous familial and nonfamilial) hypercholesterolemia, either alone or with an HMG-CoA reductase inhibitor. The first drug in a new class of cholesterol-lowering agents since the first statin was approved in 1987.
* Recommended Dosage: 10 mg once a day.
* Special Considerations: Side effects in trials were similar in treated patients and those on placebo.
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* Comment: Treatment with Zetia, which blocks cholesterol absorption in the intestinal tract, reduces LDL cholesterol by about 20%. The effect “is additive to statins…and is comparable with tripling the dose of the statin, as far as efficacy is concerned,” said Dr. Michael Davidson, director of preventive cardiology at Rush-Presbyterian–St. Luke’s Medical Center, Chicago. He expects Zetia to be used mostly in combination with a statin, not only for getting patients to National Cholesterol Education Program II target LDL cholesterol goals, but also to be used as monotherapy or for patients intolerant of statins.
Dr. Davidson was an investigator in an 8-week study of more than 700 patients with primary hypercholesterolemia with coronary heart disease or multiple cardiac risk factors, who were taking a statin but had nor met their LDL cholesterol goal. Among those who had Zetia added to their treatment, 72% reached their goal, vs. 19% of those given a placebo. In trials, Zetia was well tolerated and easy to use, he noted.
Zetia costs about $1.93 per pill (catalog price for direct purchasers). This is “roughly equivalent” to adding 80 mg of a nongeneric statin to 10 mg of the same statin, and provides similar efficacy, said Dr. Davidson, who is on Merck’s speakers’ bureau.
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