Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, Seoul, Republic of Korea.
Clin Ther. 2018 May;40(5):676-691.e1. doi: 10.1016/j.clinthera.2018.03.010. Epub 2018 Apr 17.
Hypertension and dyslipidemia are 2 risk factors of cardiovascular disease that often present simultaneously. Traditionally, treatment of these multiple conditions required separate medications for each disease, which may result in poor compliance and thus lead to possible treatment failure. Fixed-dose combination (FDC) therapy with a single pill may be a solution in these situations.
This multicenter, 8-week, randomized, double-blind, Phase III study evaluated the efficacy and safety of FDC treatment with telmisartan (80 mg) and rosuvastatin calcium (20 mg) in Korean patients with mild to moderate hypertension and dyslipidemia. Patients were randomly assigned to 4 groups: (1) FDC drug (80 mg of telmisartan and 20 mg of rosuvastatin); (2) 80 mg of telmisartan; (3) 20 mg of rosuvastatin; or (4) placebo. After 8 weeks of treatment, the change in mean sitting systolic blood pressure (MSSBP) and mean sitting diastolic blood pressure (MSDBP) between the FDC group and the rosuvastatin group, and the percent change in LDL-C between the FDC group and the telmisartan group, were compared.
A total of 210 patients were enrolled in the study (84 in the FDC group, 42 in the rosuvastatin group, 43 in the telmisartan group, and 41 in the placebo group). The reduction in blood pressure was significantly greater in the FDC group than in the rosuvastatin group after 8 weeks of treatment (least squares mean change from baseline, -16.1 [1.6] mm Hg vs -1.7 [2.2] mm Hg [P < 0.001] for MSSBP; -8.8 [1.0] mm Hg vs -1.6 [1.4] mm Hg [P < 0.001] for MSDBP). Least squares mean percent change in LDL-C from baseline was also significantly greater in the FDC group compared with the telmisartan group (-49.3% [2.2%] vs 1.5% [3.0%]; P < 0.001). FDC therapy also had a higher rate of achieving the treatment goal in both blood pressure (60% vs 45%; P = 0.024) and LDL-C (88.8% vs 16.3%; P < 0.001) compared with rosuvastatin or telmisartan alone, respectively. In regression analysis, higher baseline MSSBP, female sex, and lower body mass index were associated with increased reductions in MSSBP, whereas higher baseline LDL-C level and lower body mass index were associated with greater reductions in LDL-C. There were 48 adverse events in 36 patients (17.3% [36 of 208]), and 17 adverse drug reactions in 12 patients (5.8% [12 of 208]), indicating no significant differences in short-term safety among study groups.
Treatment with an FDC drug containing telmisartan and rosuvastatin showed similar efficacy in lowering blood pressure and LDL-C levels compared with that of each single drug. ClinicalTrials.gov identifier: NCT01914432.
高血压和血脂异常是心血管疾病的 2 个风险因素,常同时存在。传统上,治疗这些多种疾病需要针对每种疾病单独使用药物,这可能导致依从性差,从而导致可能的治疗失败。固定剂量联合(FDC)治疗用单一药丸可能是这些情况下的一种解决方案。
这项多中心、8 周、随机、双盲、III 期研究评估了在韩国患有轻度至中度高血压和血脂异常的患者中,替米沙坦(80mg)和瑞舒伐他汀钙(20mg)的 FDC 治疗的疗效和安全性。患者被随机分为 4 组:(1)FDC 药物(替米沙坦 80mg 和瑞舒伐他汀 20mg);(2)80mg 替米沙坦;(3)20mg 瑞舒伐他汀;或(4)安慰剂。在 8 周的治疗后,比较 FDC 组和瑞舒伐他汀组之间平均坐位收缩压(MSSBP)和平均坐位舒张压(MSDBP)的变化,以及 FDC 组和替米沙坦组之间 LDL-C 的百分比变化。
共有 210 名患者入组研究(FDC 组 84 名,瑞舒伐他汀组 42 名,替米沙坦组 43 名,安慰剂组 41 名)。在 8 周的治疗后,FDC 组的血压下降明显大于瑞舒伐他汀组(从基线的最小平方均值变化,替米沙坦组为-16.1[1.6]mmHg,瑞舒伐他汀组为-1.7[2.2]mmHg[P<0.001];替米沙坦组为-8.8[1.0]mmHg,瑞舒伐他汀组为-1.6[1.4]mmHg[P<0.001])。FDC 组与替米沙坦组相比,从基线的 LDL-C 百分比变化的最小平方均值也显著更大(-49.3%[2.2%]与 1.5%[3.0%];P<0.001)。FDC 治疗在血压(60%对 45%;P=0.024)和 LDL-C(88.8%对 16.3%;P<0.001)方面也具有更高的达到治疗目标的比率,与单独使用瑞舒伐他汀或替米沙坦相比。在回归分析中,较高的基线 MSSBP、女性性别和较低的体重指数与 MSSBP的降低幅度增加相关,而较高的基线 LDL-C 水平和较低的体重指数与 LDL-C 的降低幅度增加相关。36 名患者中有 48 例不良事件(17.3%[36 例 208 例]),12 名患者有 17 例药物不良反应(5.8%[12 例 208 例]),表明各组在短期安全性方面无显著差异。
含替米沙坦和瑞舒伐他汀的 FDC 药物治疗在降低血压和 LDL-C 水平方面与每种单一药物的疗效相似。临床试验标识符:NCT01914432。