Effectiveness and safety of atorvastatin/ ezetimibe fixed-dose combination in hypercholesterolemia: a systematic review and network meta-analysis.
Juying Qian, Xingxin Zhang, Qing Li et al.
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In 30 seconds
This systematic review and network meta-analysis compared atorvastatin alone with atorvastatin/ezetimibe free-equivalent and fixed-dose combinations in people with hypercholesterolemia. It included 46 randomized trials involving 10,567 participants. Compared with atorvastatin monotherapy, the fixed-dose combination produced a greater percentage reduction in LDL-C (mean difference -13.94%, 95% CI [-18.90% to -9.10%]); the free-equivalent combination also reduced LDL-C more. No significant differences in safety profiles were observed between treatments.
Key findings
- LDL-C reduction was greater with fixed-dose combination than atorvastatin alone (MD -13.94%, 95% CI [-18.90% to -9.10%]).
- The free-equivalent combination also reduced LDL-C more than atorvastatin alone (MD -12.41%, 95% CI [-14.61% to -10.22%]).
- LDL-C goal attainment was higher with free-equivalent combination than monotherapy (RR 1.87, 95% CI [1.47-2.39]); the fixed-dose estimate was RR 1.80 (95% CI [0.85-3.81]).
- No significant differences in safety profiles were observed between combination therapies and atorvastatin monotherapy.
Why it matters
For patients with hypercholesterolemia who do not reach LDL-C targets on statin monotherapy, these pooled trial findings indicate that adding ezetimibe can improve LDL-C lowering. The analysis also found no significant safety-profile differences, while the fixed-dose combination ranked highest for LDL-C reduction. These results help frame the potential benefits and tolerability of combination therapy.