Combining ezetimibe with statin in treating non-alcoholic fatty liver disease (NAFLD)
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on October 12th, 2022
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Highly potent statin, such as rosuvastatin, is the first-line therapy for non-alcoholic fatty liver disease (NAFLD). However, these powerful statins, especially in high doses, carry with them a battery of side effects. Thus, it is essential to find complementary agents with minimal collateral effect to substitute for high-dose statin. A study conducted by physicians and scientists at Yonsei University had reported on the potential of adding ezetimibe to the current therapy.
The clinical trials included 70 patients that had been diagnosed with NALFD. Half of them were randomly assigned to receive either a combination therapy of ezetimibe 10 mg and rosuvastatin 5 mg or a statin monotherapy of rosuvastatin 5 mg. The patients received their treatment daily for 24 weeks. Using magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) and transient elastography (TE), the study reported that both therapy schemes reduced the percentage of fat accumulation and the degree of fibrosis in the liver. Both therapy also improved other related parameters such as: body mass index (BMI), waist circumference, the amount of triglyceride, LDL-cholesterol, and C-reactive protein (CRP). Also, both schemes were well tolerated, as none of the participants reported any adverse events. However, the study did not detect any difference to liver fat compositing using magnetic resonance elastography (MRE).
When comparisons were made between the groups, combination therapy is more effective than monotherapy in reducing fibrosis and fat percentage as detected by MRI-PDFF and TE. In addition, ezetimibe combination treatment was more effective in patients with a higher BMI, type 2 diabetes mellitus, sarcopenia, and a high level of insulin resistance. Other safety surveillance data had indicated that ezetimibe, by itself, causes little adverse effects. Thus, healthcare providers should be aware of the potential benefit of combining ezetimibe to statin therapy in treating NAFLD.
The clinical trials included 70 patients that had been diagnosed with NALFD. Half of them were randomly assigned to receive either a combination therapy of ezetimibe 10 mg and rosuvastatin 5 mg or a statin monotherapy of rosuvastatin 5 mg. The patients received their treatment daily for 24 weeks. Using magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) and transient elastography (TE), the study reported that both therapy schemes reduced the percentage of fat accumulation and the degree of fibrosis in the liver. Both therapy also improved other related parameters such as: body mass index (BMI), waist circumference, the amount of triglyceride, LDL-cholesterol, and C-reactive protein (CRP). Also, both schemes were well tolerated, as none of the participants reported any adverse events. However, the study did not detect any difference to liver fat compositing using magnetic resonance elastography (MRE).
When comparisons were made between the groups, combination therapy is more effective than monotherapy in reducing fibrosis and fat percentage as detected by MRI-PDFF and TE. In addition, ezetimibe combination treatment was more effective in patients with a higher BMI, type 2 diabetes mellitus, sarcopenia, and a high level of insulin resistance. Other safety surveillance data had indicated that ezetimibe, by itself, causes little adverse effects. Thus, healthcare providers should be aware of the potential benefit of combining ezetimibe to statin therapy in treating NAFLD.