my personal edition > cholesterol/lipid disorders > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Rosuvastatin Achieves LDL-C Goal When Other Statins Fall Short: Presented at ACC

By Bruce Dixon

CHICAGO, IL -- April 1, 2003 -- Patients requiring aggressive lipid-modifying therapy may benefit by switching from their current statin drug to rosuvastatin, according to researchers.

This finding, a result of the MERCURY I trial involving over 3,100 adults with -- or at high risk of -- coronary heart disease, was presented here on March 30^th at the 52^nd Annual Scientific Session of the American College of Cardiology.

Lead author Herbert Schuster, MD, of Humboldt University in Berlin, Germany, said the objective of the 16-week, multicenter, randomized, open-label study was to learn how many patients were reaching treatment goals, rather than merely to compare lowering rate percentages. "We would like to show patients and physicians that patients benefit most from statin treatment. The current strategy is to estimate global cardiovascular risk, define the corresponding treatment goal, and just treat the patient down to that goal," he said.

"These were average patients as often seen in primary care with high CV disease risk, CHD, CHD equivalent, diabetes, or a 10-year CV risk above 20%. Only about 50% of patients on statin drugs reach their treatment goals, so there's a clear need for more efficacious statins."

Following a 6-week dietary lead-in and compliance with the National Cholesterol Education Program step I diet, patients were randomized to initial treatment for 8 weeks and to maintain or switch treatment for another 8 weeks. They initially received rosuvastatin 10 mg, atorvastatin 20 mg, simvastatin 20 mg, or pravastatin 40 mg. Patients either remained on these treatments for another 8 weeks or switched treatments. To simulate the actual prescribing practices of physicians, those who were switched from one treatment to another after 8 weeks did not undergo a treatment washout phase.

The primary efficacy measure was the proportion of patients reaching the joint European LDL-C goal of <3.0 mmol/L at 16 weeks. At 8 weeks, rosuvastatin 10 mg brought 88% of patients to the primary goal, compared with: 76% for atorvastatin 10 mg; 84% for atorvastatin 20 mg; 69% for simvastatin 20 mg; and 62% for pravastatin 40 mg. Similar results were achieved for secondary efficacy measures derived from the NCEP Adult Treatment Panel III LDL-C goals.

At 16 weeks, patients switched to rosuvastatin again were more likely to achieve joint European and ATP III LDL-C treatment goals. Goals were attained by 80% of those on atorvastatin 10 mg, 72% of patients taking simvastatin 20 mg, and 66% of those on pravastatin 40. Switching them to rosuvastatin 10 mg increased attainment to 86%, while changing from atorvastatin 20 mg to rosuvastatin 20 mg hiked attainment of goals from 84% to 90%.

The authors said all study treatments were well tolerated throughout the 16-week trial.

"The take-home message," said Dr. Schuster, "is if you start with rosuvastatin 10 mg, you have a higher likelihood that you don't have to uptitrate patients; that means you don't have to explain why high dosage might be necessary, and you don't have to repeat safety profile measurements. You're also saving money. Probably the most important outcome is that we are assuring physicians that they have the highest likelihood that their patients benefit most from the statin therapy reaching the target goals."


[Study title: Effects of Switching to Rosuvastatin From Atorvastatin or Other Statins on Achievement of International Low-Density Lipoprotein Cholesterol Goals: MERCURY I Trial. Abstract: 1010-149]

E-Mail this DGDispatch to a colleague

To print, use this version