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Lopid (Gemfibrozil) May Increase Low-density Lipoprotein Levels in Some Patients: Presented at ASHP

By Bonnie Darves
Special to DG News

ATLANTA, GA -- December 16, 2002 -- Early results of an ongoing study show that gemfibrozil (Lopid) actually increase low-density lipoprotein (LDL) cholesterol levels in some patients.

Researchers from the Central Alabama Veterans Health Care System, in Birmingham, Alabama, United States, presented their findings here December 11^th at the clinical meeting of the American Society of Health-System Pharmacists.

The results to date are noteworthy, the researchers said, because they differ from findings of earlier studies and because gemfibrozil remains a recommended treatment for patients with elevated triglyceride levels. Some studies on gemfibrozil, for example, have demonstrated plasma triglyceride concentration reductions of up to 35 percent. In addition, the drug is among recommended treatments for individuals whose triglycerides exceed 200 mg/dL, according to the most recent guidelines from the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III), the researchers noted.

The study included an outpatient veteran population enrolled in a pharmacy-operated lipid clinic, who were treated with gemfibrozil between June 2001 and June 2002. Of the 84 patients identified, 26 were excluded because their LDL levels pre- and post-therapy could not be documented. The final study population included 55 men and two women. Of those patients, 63 percent (36) were on concurrent lipid-lowering medications: 29 patients were on simvastatin, four were on atorvastatin, two took fish oil and one patient was on nicotinic acid.

Over the year of study, LDL levels increased in 38 (67 percent) of the patients and decreased in the remaining 19 patients, with an average increase in LDL cholesterol values of 13.88 mg/dL over baseline.

Joy Cherry, lead researcher, said the results were especially surprising given the high number of patients taking concurrent lipid-lowering therapy and the fact that the Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial (VA-HIT) had demonstrated no change in LDL levels before and after treatment with gemfibrozil.

The researchers said that although the LDL increases are not likely to reach statistical significance, they are clinically significant and merit both close monitoring of patients on gemfibrozil and greater physician awareness of the potential need to consider alternative therapy.

The study will be continued to determine whether these results are replicated as new lipid clinic patients are enrolled.

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