"This study shows that until the ongoing large study of [ezetimibe] is completed, the clinical effectiveness of [ezetimibe] is unknown and the drug should be reserved for those patients who cannot achieve suitable cholesterol levels with statins alone or with a combination of statins and niacin," he added.
"For patients who cannot reach their cholesterol goals with statin therapy alone, this study, though small, shows that niacin is a much better choice than ezetimibe as an add-on medication. Until there is an outcomes trial, ezetimibe and Vytorin should be drugs of last resort. This study further reinforces our recommendations that statins should always be the first-line treatment," Weaver said.
Taylor carefully avoided making claims about the efficacy of ezetimibe, although he acknowledged that a number of studies have questioned the efficacy of the drug, and he has authored editorials that questioned the compound's efficacy.
Ray Gibbons, professor of medicine at the Mayo Clinic in Rochester, pointed out that the patients in the study were already quite well-managed, as most had LDLs of less 100 mg/dL, so they can hardly be considered typical.
"In my practice, I follow previous outcomes studies (and AHA position), i.e., niacin is the preferred second agent if statins at maximum tolerated dose do not get patients to target," Gibbons said.