Effectiveness and tolerability of adding ezetimibe to niacin-based regimens for treatment of primary hyperlipidemia.

OBJECTIVE: To determine the effectiveness and tolerability of adding ezetimibe, 10 mg daily, to niacin-based regimens for dyslipidemia. METHODS: We conducted a retrospective review of medical records of 53 patients in 2 lipid clinics who received ezetimibe as add-on therapy to stable doses of niacin and other lipid medications. Mean percentage changes of lipoprotein cholesterol and triglyceride levels were determined. Safety and tolerability measures included adverse events, serum hepatic transaminases, and hemoglobin A1c (in patients with diabetes). RESULTS: Most study subjects (81%) had established atherosclerotic disease. The niacin formulation was extended-release in 31 patients (58%), immediate-release in 17 (32%), and slow-release in 5 (9%). Most patients (75%) were also taking a statin. Add-on ezetimibe therapy yielded mean reductions of 18% for total cholesterol (P<0.001), 25% for low-density lipoprotein (LDL) cholesterol (P<0.001), and 17% for triglycerides (P<0.001). High-density lipoprotein (HDL) cholesterol did not change significantly (+2%). Only 7 patients (13%) met Adult Treatment Panel III (ATP III) LDL cholesterol goals before the addition of ezetimibe, but 24 (45%; P<0.001 compared with baseline) attained these goals after addition of ezetimibe to the therapeutic regimen. Ezetimibe effectiveness did not correlate with the baseline dose of niacin or the dose/efficacy of the statin used. The addition of ezetimibe to niacin-based therapy for dyslipidemia was well tolerated. No patient had clinically significant elevations in hepatic enzyme or hemoglobin A1c levels or discontinued the ezetimibe therapy permanently. CONCLUSION: In our study, the addition of ezetimibe to niacin-based regimens lowered the LDL cholesterol level by 25% and did not change the level of HDL cholesterol. This combination can be useful in multidrug regimens for high-risk patients with dyslipidemia who are not achieving ATP III treatment goals.

Effectiveness and tolerability of ezetimibe add-on therapy to a bile acid resin-based regimen for hypercholesterolemia.

Combination lipid-reducing therapy is increasingly used, particularly for the management of severe or combined dyslipidemia in patients at high risk for coronary heart disease. To assess the potential additive effects of combining the cholesterol absorption inhibitor ezetimibe with a bile acid resin (BAR), a prospective chart review was performed of 40 patients in whom ezetimibe 10 mg/day was added to a stable regimen that included a BAR. At an average follow-up of 107 +/- 57 days, ezetimibe coadministration significantly reduced total cholesterol by 18%, triglycerides by 14%, and low-density lipoprotein cholesterol by 19% (all p < or =0.03), without significantly changing high-density lipoprotein cholesterol, and the combination was well tolerated.

Demographics and attitudes of chronic-pain patients who seek online pain-related medical information: implications for healthcare providers.

OBJECTIVE: To identify the demographics, search characteristics, and attitudes of chronic-pain patients who access online pain-related medical information. DESIGN: This is a cross-sectional survey study. RESULTS: Ninety percent of patients had access to the Internet; 63% of patients used the Internet to obtain online pain-related medical information, of which 57% and 55% believed that the information was "useful" and "credible," respectively. Ninety-five percent of current online pain-related medical information users and 52% of nonusers planned to use the Internet in the future to obtain online pain-related medical information. Only half of our subjects ever shared the information found on Internet with their treating healthcare provider. CONCLUSIONS: A large proportion of chronic-pain patients use the Internet to obtain online pain-related medical information. This behavior was found to show significant correlation with patients' level of education. Despite multiple previous studies suggesting inaccurate and low quality of online medical information, most of the patients felt confident in the credibility of online pain-related medical information obtained. Furthermore, many patients choose not to share this information with their healthcare providers. Healthcare providers must acknowledge the growing importance of Internet-based health information, be prepared to entertain questions and assist patients in evaluating the quality of online pain-related medical information, and possibly proactively suggest quality third-party pain-related websites.