Mohiuddin Syed M, Pepine Carl J, Kelly Maureen T, Buttler Susan M, Setze Carolyn M, Sleep Darryl J, Stolzenbach James C
The Creighton Cardiac Center, Omaha, NE 68131, USA.
Am Heart J. 2009 Jan;157(1):195-203. doi: 10.1016/j.ahj.2008.08.027. Epub 2008 Nov 20.
Patients with mixed dyslipidemia often require combination therapy to effectively control lipid abnormalities. This study compared the effects of combination therapy with ABT-335 (a new formulation of fenofibric acid) and simvastatin to ABT-335 and simvastatin monotherapies on lipid and nonlipid parameters in patients with mixed dyslipidemia.
This was a phase 3, multicenter, randomized, double-blind, active-controlled study. A total of 657 patients with mixed dyslipidemia (low-density lipoprotein cholesterol [LDL-C] > or =130 mg/dL, triglycerides [TGs] > or =150 mg/dL, and high-density lipoprotein cholesterol [HDL-C]<40 mg/dL [men] or <50 mg/dL [women]) were randomized to 12 weeks of treatment with ABT-335 + simvastatin (20 or 40 mg) combination therapy, ABT-335 monotherapy (135 mg), or simvastatin monotherapy (20, 40, or 80 mg).
Combination therapy resulted in significantly greater increases in HDL-C and decreases in TGs compared to the corresponding simvastatin monotherapy dose (P < .001) and decreases in LDL-C compared to ABT-335 monotherapy (P < .001). HDL-C increased 17.8% versus 7.2% and TGs decreased -37.4% versus -14.2% (ABT-335 + simvastatin 20 vs simvastatin 20); LDL-C decreased -24.0% versus -4.0% (ABT-335 + simvastatin 20 vs ABT-335). HDL-C increased 18.9% versus 8.5% and TGs decreased -42.7% versus -22.4% (ABT-335 + simvastatin 40 vs simvastatin 40); LDL-C decreased -25.3% versus -4.0% (ABT-335 + simvastatin 40 vs ABT-335). Twelve-week treatment with combination therapy was generally well tolerated with a safety profile consistent with ABT-335 and simvastatin monotherapies. No cases of rhabdomyolysis were reported.
For patients with mixed dyslipidemia, combination therapy provided more effective control of multiple lipid parameters than either monotherapy alone, with a safety profile similar to both monotherapies.
混合性血脂异常患者通常需要联合治疗以有效控制血脂异常。本研究比较了ABT - 335(非诺贝特酸的新制剂)与辛伐他汀联合治疗与ABT - 335和辛伐他汀单药治疗对混合性血脂异常患者血脂和非血脂参数的影响。
这是一项3期、多中心、随机、双盲、活性对照研究。总共657例混合性血脂异常患者(低密度脂蛋白胆固醇[LDL - C]≥130mg/dL,甘油三酯[TGs]≥150mg/dL,高密度脂蛋白胆固醇[HDL - C]<40mg/dL[男性]或<50mg/dL[女性])被随机分配接受12周的ABT - 335 +辛伐他汀(20或40mg)联合治疗、ABT - 335单药治疗(135mg)或辛伐他汀单药治疗(20、40或80mg)。
与相应的辛伐他汀单药治疗剂量相比,联合治疗导致HDL - C显著升高且TGs降低(P<.001),与ABT - 335单药治疗相比LDL - C降低(P<.001)。HDL - C升高17.8%对比7.2%,TGs降低-37.4%对比-14.2%(ABT - 335 +辛伐他汀20mg对比辛伐他汀20mg);LDL - C降低-24.0%对比-4.0%(ABT - 335 +辛伐他汀20mg对比ABT - 335)。HDL - C升高18.9%对比8.5%,TGs降低-42.7%对比-22.4%(ABT - 335 +辛伐他汀40mg对比辛伐他汀40mg);LDL - C降低-25.3%对比-4.0%(ABT - 335 +辛伐他汀40mg对比ABT - 335)。联合治疗12周总体耐受性良好,安全性与ABT - 335和辛伐他汀单药治疗一致。未报告横纹肌溶解病例。
对于混合性血脂异常患者,联合治疗比单独使用任何一种单药治疗能更有效地控制多种血脂参数,且安全性与两种单药治疗相似。