Merck/Schering-Plough Pharmaceuticals announced that the US Food and Drug Administration (FDA) has approved Zetia (ezetimibe) for use, along with diet, in combination with fenofibrate for the reduction of elevated total cholesterol and LDL "bad" cholesterol in patients with mixed hyperlipidemia, when diet alone is not enough.
Zetia is the first in a class of cholesterol-lowering agents that inhibits the intestinal absorption of cholesterol through a unique mechanism of action, stated a Merck release.
With this new indication, Zetia offers patients with mixed hyperlipidemia another treatment option when it is prescribed in combination with fenofibrate. Fenofibrate is commonly used along with diet to treat hyperlipidemia and has proven efficacy in lowering triglyceride levels and increasing HDL "good" cholesterol. The use of Zetia with fibrates other than fenofibrate is not recommended until use in patients is studied.
Mixed hyperlipidemia is a metabolic disorder characterized by elevated LDL cholesterol, elevated triglycerides (a form of fat in the bloodstream), and reduced levels of HDL cholesterol.
"This is an exciting new development in the treatment of mixed hyperlipidemia. Zetia and fenofibrate taken together offer complementary lowering of LDL and total cholesterol in patients with mixed hyperlipidemia," said Harold E. Bays, M.D., medical director, president of L-MARC Research Center, Louisville, KY.
Approval was based on the results from a clinical trial which showed that combination therapy of 10 mg of Zetia co-administered with 160 mg of fenofibrate significantly reduced LDL cholesterol levels when compared to either treatment alone (p<0.001). Patients in a 12-week study who were co-administrated Zetia 10 mg and fenofibrate 160 mg (n=183) showed a 20 percent reduction in LDL cholesterol levels compared to a 6 percent reduction in LDL cholesterol levels with 160 mg fenofibrate as monotherapy (n=188) and a 13 per cent reduction in LDL cholesterol levels with 10 mg Zetia as monotherapy (n=185).
The study consisted of patients with mixed hyperlipidemia; 625 patients were treated for up to 12 weeks with 576 of these patients continuing treatment for up to an additional 48 weeks. The changes in lipid endpoints after an additional 48 weeks of treatment with Zetia co-administered with fenofibrate or with fenofibrate alone were consistent with the 12-week data.
In this study, Zetia co-administered with fenofibrate appeared to be well tolerated. For patients taking Zetia and fenofibrate in whom gallstones (cholelithiasis) are suspected, physicians should perform gallbladder studies and consider alternative lipid-lowering therapy. While this study was not designed to compare how often infrequent events occurred, the rates for gallbladder removal (cholecystectomy) were 0.6 percent for fenofibrate alone and 1.7 per cent for Zetia and fenofibrate together.
Zetia, along with diet, is indicated for use either by itself or together with statins or fenofibrate in patients with high cholesterol to reduce LDL cholesterol and total cholesterol when the response to diet and exercise has been inadequate. Zetia, which works in the digestive tract, is complementary to the class of cholesterol-lowering agents known as statins, which work in the liver to reduce the production of cholesterol. Zetia, alone or in combination with statins, has been proven to significantly improve LDL cholesterol levels. Zetia, either alone or in addition to a statin or fenofibrate, has not been shown to prevent heart disease or heart attacks.
Merck/Schering-Plough Pharmaceuticals is a joint venture between Merck & Co., Inc. and Schering-Plough Corporation formed to develop and market in the United States new prescription medicines in cholesterol management. The collaboration includes worldwide markets (excluding Japan). Zetia is marketed as EZETROL in more than 50 nations outside the U.S.