Transcript Ezetimibe

What’s the point of Ezetimibe?
MeReC
http://www.npc.co.uk/ebt/merec/car
dio/cdlipids/merec_extra_no47.html
Why are we prescribing it?
• £85 million a year in primary care in
England up to June 2010
• Does this represent good value for money
and rational expenditure?
MeReC’s advice is that we should review,
and where appropriate, revise prescribing
of ezetimibe to ensure it is in line with
NICE guidance
Quick reminder of NICE
guidance…
• First line for primary prevention or secondary prevention
should be simvastatin 40 mg
• For secondary prevention (without acute coronary
syndrome) simvastatin can be increased to 80 mg in
those patients with a cholesterol > 4 mmol/L and an LDL
> 2 mmol/L
Ezetimibe is recommended as an option only in the
following circumstances
• Where statins are contraindicated or not tolerated
• In conjunction with a statin where serum total or LDL
cholesterol is not appropriately controlled (after
appropriate dose titration)
What’s the problem with using ezetimibe
routinely with simvastatin?
• Cost increases considerably
• No evidence that adding in ezetimibe improves
outcomes.
• Evidence for the efficacy of ezetimibe is based on
surrogate outcomes (i.e. lowering cholesterol), not on the
drug itself.
• No evidence of any improved tolerability over simvastatin
80 mg or other NICE-recommended statins.
• We rarely use other cholesterol-lowering meds now
(because of lack of evidence base), so why use
ezetimibe?