|
Zetia - Vytorin: What Our Patients Need To Know We are evaluating whether to stop Zetia (or Vytorin which contains Zetia) and
switch patients to their statin medication (Crestor, Lipitor, etc.) along with either Trilipix, or Niaspan. The following excerpt from the New England Journal of Medicine was a response to the study. It basically
concludes that the evidence is suggestive that Niacin works better than Zetia, but a conflicting study exists, and that the study was small and possibly biased. It shows no danger from Zetia, just better heart
protection from Niaspan. The Zetia lowers 'bad' cholesterol by 20%, but it may not be protecting the heart.
We often use Niaspan, but it is a little more difficult to tolerate as it sometimes causes a
non-dangerous but uncomfortable flushing sensation in the first month of use. The flushing is minimized by taking an aspirin 30 minutes before the Niaspan, and taking it with a small snack, such as applesauce. The
flushing diminishes after a few weeks.
New England Journal excerpt: "Post hoc analyses are very sensitive to bias due to confounding. In this trial, multivariable models should have been used. At a minimum, an analysis for
interaction should have been performed to give statistical support for the fact that the relationship between changes in LDL cholesterol level and carotid intima–media thickness was
indeed different between the two groups, beyond what would be expected due to chance. The conclusions about this relationship from the post hoc analysis in the ARBITER
6–HALTS study are at odds with those in the recent report of the SANDS (Stop Atherosclerosis in Native Diabetics Study) trial (NCT00047424 [ ClinicalTrials.gov] ),3 in which the addition
of ezetimibe to statin therapy was associated with the prevention of a progression of carotid intima–media thickness. However, both the ARBITER 6–HALTS and SANDS studies are
small and used a surrogate marker; we believe that firm conclusions about this relationship must await the findings of large studies involving clinical end points."
So there is no urgency to switch, and we will weigh options in each patient individually at the time of the next office visit until further definitive studies resolve the issue.
If concerned, call and get in with one of the doctors, not one of the pa's, to discuss the issue and to consider a plan to switch medications. |
