Ezetimibe safe treatment option for patients who need lipid-lowering treatment

A study was conducted to determine the harms of ezetimibe in people who need lipid-lowering treatment. Studies comparing ezetimibe with placebo, standard care, or other lipid-lowering agents in people who need lipid-lowering treatment with a follow-up duration of at least six months (or 24 weeks). The relative effects for potential harms of ezetimibe were pooled using random effect pairwise meta-analyses for randomised controlled trials. The evidence from observational studies was narratively summarised. The certainty of the evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation.

Results:

• 48 randomised controlled trials with 28 444 participants (median follow-up 34 weeks, range 24-312 weeks) and four observational studies with 1667 participants (median follow-up 282 weeks, range 72-400 weeks) were included.
• The meta-analyses of randomised trials showed moderate to high certainty that ezetimibe was not associated with cancer (relative risk 1.01; 95% confidence interval 0.92 to 1.11), fractures (0.90; 0.74 to 1.10), discontinuation due to any adverse event (0.87; 0.74 to 1.03), gastrointestinal adverse events leading to discontinuation (1.34; 0.58 to 3.08), myalgia or muscular pain leading to discontinuation (0.82; 0.51 to 1.33), neurocognitive events (1.48; 0.58 to 3.81), or new-onset diabetes (0.88; 0.61 to 1.28).
• The narrative analysis of observational studies provided consistent findings.
• No credible subgroup effects were identified for the harm outcomes, including shorter versus longer follow-up duration of trials.

Thus, Ezetimibe results in little to no difference in adverse events or other undesirable effects compared with placebo, usual care or other lipid-lowering agents.

Reference:

Safety of ezetimibe in lipid-lowering treatment: systematic review and meta-analysis of randomised controlled trials and cohort studies by Yang Wang et al. published in the BMJ Medicine.