Table 12Mid potency statin in combination with ezetimibe as compared to high potency statin monotherapy in general populations: strength of evidence

OutcomeNo. Studies
(N)
Risk of BiasDirectnessConsistencyPrecisionReporting Bias

Other Issues
Findings and Magnitude of EffectStrength of Evidence
Long-Term Benefits and Serious Adverse Events
Mortality6a
(1565)
LowDirectInconsistentImprecise
[does not meet OIS of 4864]
Not detected

None
Very few events; similar mortality in combination therapy and monotherapy arms.Insufficient
Acute Coronary Events1
(596)
LowDirectNAImpreciseNot detected

None
Only one event occurring in a combination arm.Insufficient
Revascularization ProceduresNoneNANANANANANo eligible studiesInsufficient
Serious Adverse Events2
(1391)
LowDirectConsistent
[no statistically significant difference in SAE in any comparison]
Imprecise
[does not meet OIS of 1490]
Not detected

None
No difference.Insufficient
Surrogate Clinical Outcomes
LDL-c11a
(6694)
LowIndirect

[LDL calculated not directly measured in most trials]
Consistent

[Eight studies favored combination therapy, two were neutral, two favored monotherapy]
ImpreciseNot detected

None
Eight comparisons favored combination therapy for lowering LDL-c as compared to monotherapy (difference 3 percent to 14 percent)Moderate
HDL-c10a
(6434)
LowDirect

[HDL directly measured]
Inconsistent

[Six studies favored combination therapy, five neutral]
ImpreciseNot detected

None
Six comparisons favored combination therapy for raising HDL-c as compared to monotherapy (difference 1.8 percent to 6 percent)Low

HDL = high-density lipoprotein; LDL = low-density lipoprotein; NA = not applicable

a

Missing N in at least one trial.

From: Results

Cover of Combination Therapy Versus Intensification of Statin Monotherapy: An Update
Combination Therapy Versus Intensification of Statin Monotherapy: An Update [Internet].
Comparative Effectiveness Reviews, No. 132.
Monroe AK, Gudzune KA, Sharma R, et al.

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