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Combo Treatment Improves Lipid Profile in Hyperlipidemia

Ezetimibe, simvastatin, niacin more effective than individual agents

WEDNESDAY, April 16 (HealthDay News) -- A combination of ezetimibe, simvastatin and extended-release niacin is more effective than the individual agents in improving the lipid profile of patients with hyperlipidemia, researchers report in the April 22 issue of the Journal of the American College of Cardiology.

John R. Guyton, M.D., from Duke University Medical Center in Durham, N.C., and colleagues randomly assigned 1,220 patients with type IIa or IIb hyperlipidemia to one of three treatments: extended-release niacin; ezetimibe/simvastatin; or ezetimibe/simvastatin co-administered with extended-release niacin for 24 weeks.

The researchers found that compared with the other two groups, ezetimibe/simvastatin/niacin was associated with significantly greater reductions in low-density lipoprotein cholesterol, triglycerides, non-high-density lipoprotein cholesterol, apolipoprotein B and lipid/lipoprotein ratios. The triple combination was significantly better than ezetimibe/simvastatin alone in raising apolipoprotein A-I and high-density lipoprotein, and significantly better than niacin alone in lowering high-sensitivity C-reactive protein. However, the discontinuation rate in both niacin groups was about 25 percent, primarily due to flushing, compared with 9.6 percent for ezetimibe/simvastatin.

"Combination treatment with ezetimibe/simvastatin plus extended-release niacin showed superior lipid-altering efficacy compared with extended-release niacin or ezetimibe/simvastatin in type IIa or IIb hyperlipidemia patients and was generally well tolerated aside from niacin-associated flushing," Guyton and colleagues conclude.

The study was sponsored by Merck/Schering-Plough Pharmaceuticals.

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