Table B

Summary of conclusions from evidence comparing use of a specific statin in combination with another lipid-modifying agent with use of a higher dose statin in populations requiring intensive treatment and subgroups

OutcomeStrength of Evidence (GRADE)Summary/conclusions
Key Question 1. For patients who require intensive lipid-modifying therapy, what are the comparative long-term benefits and rates of serious adverse events of coadministration of different lipid-modifying agents (i.e., a statin plus another lipid-modifying agent) compared with higher dose statin monotherapy?
All-cause mortality Very lowInsufficient evidence was available regarding mortality. Based on small trials with few events, no difference in mortality was noted for any statin combination associated with ezetimibe or fibrates compared with higher dose statin monotherapy.
No evidence was available for other combinations.
Vascular death ---No evidence was available for any statin combination vs. higher dose statin monotherapy.
Serious a adverse events Very lowUp to a maximum followup of 24 weeks, no intervention was significantly safer when statin-ezetimibe combination was compared with higher dose statin monotherapy. No evidence was available for other combinations.
Key Question 2. Do these regimens differ in reaching LDL targets (or other surrogate markers), short-term side effects, tolerability, and/or adherence?
Attainment of ATP III LDL-c goals Very lowEzetimibe plus simvastatin therapy is more likely to result in attainment of LDL-c target than higher dose simvastatin, based on 2 small trials.
Results for statin-fibrate combination (1 trial) were indeterminate.
No evidence was available for other combinations.
Key Question 3. Compared with higher dose statins and to one another, do combination regimens differ in benefits and harms within subgroups of patients?
All-cause mortality, vascular death, and attainment of ATP III LDL- c goals Very lowThere is insufficient evidence to draw any meaningful conclusions in subgroups for any combination.
Serious adverse events ---Since absent to scant subgroup evidence was anticipated, SAE was examined across all trial populations (see above).
Inter-combination, indirect comparison of syntheses We are unable to confirm a difference in benefits or harms between combinations due to the lack of evidence.
a

Because of scant evidence for those in need of intensive lipid lowering, SAE was examined across all trial populations

Abbreviations: ATP III=Adult Treatment Panel III (of the National Cholesterol Education Program); GRADE=Grading of Recommendations Assessment, Development and Evaluation; LDL-c=low-density lipoprotein cholesterol; SAE=serious adverse events.

From: Executive Summary

Cover of Comparative Effectiveness of Lipid-Modifying Agents
Comparative Effectiveness of Lipid-Modifying Agents [Internet].
Comparative Effectiveness Reviews, No. 16.
Sharma M, Ansari MT, Soares-Weiser K, et al.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.