|Posted: 11/25/2009 11:14:54 AM|
| The recent results of the ARBITER6-HALTS trial, I believe, should cause us to eliminate Zetia (ezetimibe) from our list of agents regarded as safe.|
In all honesty, despite some of the negative press on Zetia, especially in regards to the data suggesting no effect on carotid plaque in people with heterozygous familial hypercholesterolemia, I had maintained hope that a subset of people who are "hyperabsorbers" of sterol-backbone substances, such as the various forms of sterols, would benefit from Zetia's capacity to block their absorption. But the ARBITER trial, I believe, essentially closes the lid on Zetia, regardless of any potential effect on sterol absorption.
The study demonstrates that niacin in combination with a statin (mostly Lipitor or Crestor) reduces carotid intimal-medial thickness (CIMT) modestly; while Zetia does not when added to statin.
Most concerningly, greater LDL-reducing efficacy with Zetia was associated with an increase in CIMT. The authors raise the question, suggested in prior studies, that Zetia, despite being billed as only a cholesterol absorption inhibitor, exerts other effects when systemically absorbed, including impairment of reverse cholesterol transport.
I believe that enough doubt has been cast on the efficacy and safety of Zetia that we should avoid its inclusion. Of course, speak to your doctor before making any changes.