Moderate statin and ezetimibe combo non inferior to high-intensity statin monotherapy in ASCVD: RACING trial

South Korea: A moderate-intensity statin with ezetimibe combination therapy among patients with atherosclerotic cardiovascular disease (ASCVD) is non-inferior to high-intensity statin monotherapy, according to results from the RACING trial. 

The non-inferiority in the study published in The Lancet was seen with regard to the 3-year composite outcomes with lower intolerance-related drug discontinuation or dose reduction and a higher proportion of patients with LDL cholesterol concentrations of less than 70 mg/dL. 

Previous studies have suggested that drug combinations rather than increasing doses of one drug can achieve greater efficacy and lower risks. Thus, moderate-intensity statin with ezetimibe combination therapy as an alternative to high-intensity statin monotherapy can lower LDL cholesterol concentrations effectively while reducing adverse effects. However, there is a need for evidence from randomized trials to compare long-term clinical outcomes.

To fill the knowledge gap described above, a research team from South Korea led by Prof Byeong-Keuk Kim performed an open-label, non-inferiority trial that included patients with atherosclerotic cardiovascular disease at 26 clinical centers in South Korea. They were randomly assigned in a ratio of 1: 1 to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). 

The primary endpoint was the 3-year composite of cardiovascular death, non-fatal stroke, or major cardiovascular events in the intention-to-treat population with a non-inferiority margin of 2·0%.