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Abstract

Flexibility in the time of administration of statin therapy is likely to improve patient compliance. This study compared the efficacy and tolerability of morning and evening administration of the extended-release formulation of fluvastatin (fluvastatin XL). In this prospective, double-blind, multicenter, multiple dose study, 236 patients with type IIa/b hypercholesterolemia were randomized to receive fluvastatin XL, 80 mg, in the morning or evening for 8 weeks. At 8 weeks, low-density lipoprotein cholesterol levels were reduced by 34.5 and 35.0% in the morning and evening treatment groups, respectively (p = 0.0118 for non-inferiority of morning administration). There were no statistically significant differences between the morning and evening treatment groups in the changes in total cholesterol (p = 0.56), high-density lipoprotein cholesterol (p = 0.21), triglycerides (p = 0.13), apolipoprotein B (p = 0.66) and apolipoprotein AI (p = 0.88) at 8 weeks. The frequency of adverse events was slightly lower in the morning treatment group compared with the evening treatment group (27.4 vs. 35.5%). The efficacy and safety profiles of fluvastatin XL are equivalent for morning and evening administration. 2006 S. Karger AG, Basel

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Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes.

Bernard M. Y. Cheung, Chu-Pak Lau, I. Lauder … (2004)

Since 2002, there have been five major outcome trials of statins reporting findings from more than 47,000 subjects. As individual trial results differed, we performed a meta-analysis to ascertain the effectiveness and safety of statins overall and in subgroups. The aim of the study was to estimate the effect of statins on major coronary events and strokes, all-cause mortality and noncardiovascular mortality, and in different subgroups. PubMed was searched for trials published in English. Randomized placebo-controlled statin trials with an average follow up of at least 3 years and at least 100 major coronary events were included. For each trial, the statin used, number and type of subjects, proportion of women, mean age and follow up, baseline and change in lipid profile, cardiovascular and non-cardiovascular outcomes were recorded. Ten trials involving 79,494 subjects were included in the meta-analysis. Due to heterogeneity, ALLHAT-LLT was excluded from some analyses. Statin therapy reduced major coronary events by 27% (95%CI 23, 30%), stroke by 18% (95%CI 10, 25%) and all-cause mortality by 15% (95%CI 8, 21%). There was a 4% (95%CI -10, 3%) nonsignificant reduction in noncardiovascular mortality. The reduction in major coronary events is independent of gender and presence of hypertension or diabetes. The risk reduction was greater in smokers (P < 0.05). Coronary events were reduced by 23% (95%CI 18, 29%) in pravastatin trials and 29% (95%CI 25, 33%) in five trials using other statins. Pravastatin reduced strokes by 12% (95%CI 1, 21%) whilst other statins reduced strokes by 24% (95%CI 16, 32%) (P = 0.04). Statins reduce coronary events, strokes and all-cause mortality without increasing noncoronary mortality. The benefits accrue in men and women, hypertensives and normotensives, diabetics and nondiabetics, and particularly in smokers. Pravastatin appears to have less impact on strokes.

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Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients.

Dimitrios Kiortsis, G Turpin, Philippe Giral … (2000)

Treatment with lipid-lowering drugs decreases the risk of having a cardiovascular event by 30% according to several large intervention trials. However, both in these trials and in clinical practice the rate of discontinuation of medical treatment and the frequency of low compliance are high. The purpose of the study was to determine factors associated with poor compliance. We studied 193 hyperlipidemic subjects who had been referred to an out-patient clinic and who were treated with at least one antihyperlipidemic drug. The patients were asked to fill in a questionnaire which explored various factors that could possibly affect compliance. Compliance was evaluated by the percentage of pills missed during the previous month according to patient interview. Younger subjects and smokers were less compliant. Perception of frequent side-effects to the current antihyperlipidemic treatment and high number of medications were inversely correlated with compliance (P=0.0237 and P=0.0311, respectively). Frequent breaking of appointments with a physician were inversely correlated with compliance (P=0.026). The patient's perception of the time that the physician spent to explain and to discuss the different aspects of cholesterol and cardiovascular disease (CVD) was correlated with a higher compliance (P=0.0125). Patients' perception of the efficacy of antihyperlipidemic therapy to prevent a CVD event in the future was also strongly associated with adherence to treatment (P<0.001). Many factors affect compliance with antihyperlipidemic drug therapy. Good doctor-patient relationship, conviction of the efficacy of treatment and increased age are associated with compliance. Perceived high frequency of side-effects and prescription of numerous drugs negatively affect compliance.

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Pharmacodynamic effects and pharmacokinetics of a new HMG-CoA reductase inhibitor, rosuvastatin, after morning or evening administration in healthy volunteers.

Larry D. Martin, G Schneck, R. Mitchell (2002)

To compare the lipid-regulating effects and steady-state pharmacokinetics of rosuvastatin, a new synthetic hydroxy methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, following repeated morning and evening administration in volunteers with fasting serum low-density lipoprotein cholesterol (LDL-C) concentrations < 4.14 mmol l-1. In this open-label two-way crossover trial 24 healthy adult volunteers were randomized to receive rosuvastatin 10 mg orally each morning (07.00 h) or evening (18.00 h) for 14 days. After a 4 week washout period, volunteers received the alternative regimen for 14 days. Rosuvastatin was administered in the absence of food. Reductions from baseline in serum concentrations of LDL-C (-41.3%[morning]vs-44.2%[evening]), total cholesterol (-30.9%vs-31.8%), triglycerides (-17.1%vs-22.7%), and apolipoprotein B (-32.4%vs-35.3%) were similar following morning and evening administration. AUC(0,24 h) for plasma mevalonic acid (MVA), an in vivo marker of HMG-CoA reductase activity, decreased by -29.9% (morning) vs-32.6% (evening). Urinary excretion of MVA declined by -33.6% (morning) vs-29.2% (evening). The steady-state pharmacokinetics of rosuvastatin were very similar following the morning and evening dosing regimens. The Cmax values were 4.58 vs 4.54 ng ml-1, and AUC(0,24 h) values were 40.1 vs 42.7 ng ml-1 h, following morning and evening administration, respectively. There were no serious adverse events during the trial, and rosuvastatin was well tolerated after morning and evening administration. The pharmacodynamic effects and pharmacokinetics of rosuvastatin are not dependent on time of dosing. Morning or evening administration is equally effective in lowering LDL-C.

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PubMed ID:: 16691029

DOI:: 10.1159/000093200

ScienceOpen disciplines: Chemistry

Keywords: Adult,Aged,Aged, 80 and over,Anticholesteremic Agents,administration & dosage,adverse effects,Apolipoproteins B,blood,C-Reactive Protein,metabolism,Cholesterol, HDL,Cholesterol, LDL,Circadian Rhythm,Delayed-Action Preparations,Fatty Acids, Monounsaturated,Female,Homocysteine,Humans,Hypercholesterolemia,drug therapy,Indoles,Male,Middle Aged,Prospective Studies,Treatment Outcome

Efficacy and safety of fluvastatin-extended release in hypercholesterolemic patients: morning administration is equivalent to evening administration.

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Karger: Cardiovascular System

Most cited references 20

Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes.

Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients.

Pharmacodynamic effects and pharmacokinetics of a new HMG-CoA reductase inhibitor, rosuvastatin, after morning or evening administration in healthy volunteers.

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