Lipid-altering efficacy of ezetimibe/simvastatin 10/40 mg compared with doubling the statin dose in patients admitted to the hospital for a recent coronary event: the INFORCE study


  • Disclosure
    Several of the named authors are Merck or Schering-Plough employees, and as such, may hold stock in the company. Other authors were involved in the conduct of a study that was funded by Merck/Schering-Plough Pharmaceuticals, North Wales, Pennsylvania.

J. P. D. Reckless,
Royal United Hospital, Bath, UK
Tel.: + 44 (0) 1225 824527
Fax: + 44 (0) 1225 824529


Background:  The aim of this study was to investigate the efficacy and safety profile of switching to ezetimibe/simvastatin (Eze/Simva) 10/40 mg compared with doubling the statin dose upon discharge in patients taking a statin and admitted to the hospital for the investigation of a coronary event.

Design:  This phase IV, multi-centre, randomised, open-label, active-controlled, parallel group study enrolled 424 patients (aged ≥ 18 years) hospitalised for an acute coronary event and taking a stable dose of a statin (≥ 6 weeks) that could be doubled per the product label. Upon discharge from the hospital, patients were stratified by their statin dose/potency (high, medium and low) and randomised 1 : 1 to doubling of the statin dose (n = 211) or Eze/Simva 10/40 mg (n = 213) for 12 weeks. The primary efficacy variable was the absolute low-density lipoprotein cholesterol (LDL-C) value (mmol/l) at study end-point.

Results:  Mean baseline LDL-C for the two treatment groups were 2.48 and 2.31 mmol/l for the Eze/Simva and statin groups respectively. At study end-point, least squares mean LDL-C values were 1.74 mmol/l in the Eze/Simva group and 2.22 mmol/l in the statin group resulting in a significant between-group difference of −0.49 mmol/l (p ≤ 0.001). Eze/Simva 10/40 mg also produced significantly lower total cholesterol (−0.49 mmol/l), non-high-density lipoprotein cholesterol [(non-HDL-C); −0.53 mmol/l] and apolipoprotein B (−0.14 mmol/l) values compared with doubling the statin dose (p ≤ 0.001 for all). Both treatments produced similar effects on triglycerides, C-reactive protein and HDL-C; the between treatment group differences were not significant (p ≥ 0.160). Significantly more patients achieved LDL-C levels < 2.5 (< 100 mg/dl; 86% vs. 72%), < 2.0 (< 77 mg/dl; 70% vs. 42%) and < 1.8 mmol/l (< 70 mg/dl; 60% vs. 31%) with Eze/Simva than statin (all p ≤ 0.001). Eze/Simva was generally well tolerated, with a safety profile similar to statin. There were no differences in the incidences of liver transaminases ≥ 3 × upper limit of normal (ULN) or creatine kinase ≥ 10 × ULN between the groups.

Conclusions:  In patients taking a statin and admitted to the hospital for investigation of a coronary event, treatment with Eze/Simva 10/40 mg for 12 weeks produced greater improvements in lipids with a similar safety profile compared with doubling of the statin dose.