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Meta-Analysis
. 2022 Mar 4;17(3):e0264437.
doi: 10.1371/journal.pone.0264437. eCollection 2022.

Comparative safety and efficacy of low- or moderate-intensity statin plus ezetimibe combination therapy and high-intensity statin monotherapy: A meta-analysis of randomized controlled studies

Young-Mi Ah  1 , Minseob Jeong  1 , Hye Duck Choi  1
Affiliations
Meta-Analysis

Comparative safety and efficacy of low- or moderate-intensity statin plus ezetimibe combination therapy and high-intensity statin monotherapy: A meta-analysis of randomized controlled studies

Young-Mi Ah et al. PLoS One. .

Abstract

Statin is highly recommended for dyslipidemia to prevent atherosclerosis-related cardiovascular diseases and death. The aim of this study was to compare the efficacies and safeties of low/moderate-intensity statin plus ezetimibe combination therapy vs. high-intensity statin monotherapy. Meta-analysis was conducted on data included in published studies performed to compare the effects of the two treatments on lipid parameters and hs-CRP. Safety-related parameters were also evaluated. Eighteen articles were included in the meta-analysis. In terms of efficacy, low/moderate-intensity statin plus ezetimibe reduced LDL-C (SE = 0.307; 95% CI 0.153-0.463), TC (SE = 0.217; 95% CI 0.098-0.337), triglyceride (SE = 0.307; 95% CI 0.153-0.463), and hs-CRP (SE = 0.190; 95% CI 0.018-0.362) significantly more than high-intensity statin therapy. In terms of safety, the two treatments were not significantly different in terms of ALT elevation, but high-intensity statin increased AST and CK significantly more than combination therapy. This analysis indicates that low/moderate-intensity statin plus ezetimibe combined therapy is more effective and safer than high-intensity statin monotherapy, which suggests the addition of ezetimibe to statin should be preferred over increasing statin dose and that high-intensity statin should be used more carefully, especially in patients with related risks.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig 1
Fig 1. PRISMA diagram of the process for selection of relevant studies.
Fig 2
Fig 2. Forest plot of efficacy evaluation results.
Changes in LDL-C observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy. a rosuvastatin 20 mg vs. rosuvastatin 5 mg plus ezetimibe 10 mg; b rosuvastatin 20 mg vs. rosuvastatin 10 mg plus ezetimibe 10 mg; c rosuvastatin 20 mg vs. atorvastatin 10 mg plus ezetimibe 10 mg; d atorvastatin 40 mg vs. atorvastatin 10 mg plus ezetimibe 10 mg.
Fig 3
Fig 3. Forest plot of efficacy evaluation results.
Changes in TC observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy. a rosuvastatin 20 mg vs. rosuvastatin 5 mg plus ezetimibe 10 mg; b rosuvastatin 20 mg vs. rosuvastatin 10 mg plus ezetimibe 10 mg; c rosuvastatin 20 mg vs. atorvastatin 10 mg plus ezetimibe 10 mg; d atorvastatin 40 mg vs. atorvastatin 10 mg plus ezetimibe 10 mg.
Fig 4
Fig 4. Forest plot of efficacy evaluation results.
Changes in Triglyceride observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy. a rosuvastatin 20 mg vs. rosuvastatin 5 mg plus ezetimibe 10 mg; b rosuvastatin 20 mg vs. rosuvastatin 10 mg plus ezetimibe 10 mg; c rosuvastatin 20 mg vs. atorvastatin 10 mg plus ezetimibe 10 mg; d atorvastatin 40 mg vs. atorvastatin 10 mg plus ezetimibe 10 mg.
Fig 5
Fig 5. Forest plot of efficacy evaluation results.
Changes in HDL-C observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy. a rosuvastatin 20 mg vs. rosuvastatin 5 mg plus ezetimibe 10 mg; b rosuvastatin 20 mg vs. rosuvastatin 10 mg plus ezetimibe 10 mg.
Fig 6
Fig 6. Forest plot of efficacy evaluation results.
Changes in hs-CRP observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy.
Fig 7
Fig 7. Forest plot of safety evaluation results.
Changes in ALT observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy.
Fig 8
Fig 8. Forest plot of safety evaluation results.
Changes in AST observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy.
Fig 9
Fig 9. Forest plot of safety evaluation results.
Changes in CK observed for high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy.
See this image and copyright information in PMC

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