Efficacy and safety of the combination therapy of HMG CoA reductase inhibitor and fibrate in combined dyslipidemia / 대한내과학회지

ABSTRACT

BACKGROUND: The combination therapy of HMG CoA reductase inhibitor (statin) and fibrate is more effective than each ones in managing combined dyslipidemia. However, this therapy tends to be avoided due to potential risk of rhabdomyolysis. The aim of the study was to reevaluate the efficacy and safety of combination therapy. METHODS: A total 61 patients were divided into three groups according to lipid levels and medications; statin+fibrate group (n=10), statin group (n=31) and fibrate group (n=18). Patients with active hepatitis or renal dysfunction who were at high risk for complications were excluded. Lipid profiles were measured before and 2 months after medications. RESULTS: Combination therapy markedly decreased total cholesterol, low density lipoproteincholesterol (LDL-C) and triglyceride concentrations (p=0.008, p=0.028 and p=0.018 respectively), and increased high density lipoprotein-cholesterol (HDL-C)(p=0.028). The effects of this therapy on HDL-C and triglyceride were more potent than those of statin. Combination therapy was more effective in lowering LDL-C than fibrate. Serious complications such as myopathy and marked elevation of transaminase level were not observed in all groups. In statin+fibrate group, transaminase level was elevated slightly above the normal range in two cases. Creatine kinase level showed the trend to increase with borderline significance. However the levels were within normal range in 9 cases and elevated twofold in one patient. CONCLUSION: Combination therapy of statin and fibrate was effective in combined dyslipidemia and well tolerated in patients without high risk for the complications although the number of cases was small to get a conclusion.