Rosuvastatin beats pravastatin for lipid-lowering in HIV
Last Updated: 2011-01-05 13:50:08 -0400 (Reuters Health)
By Genevra Pittman
NEW YORK (Reuters Health) - In HIV patients with hyperlipidemia, rosuvastatin is far more effective than pravastatin - and guidelines should be updated to reflect that, the authors of a new paper suggest.
Although guidelines from the Infectious Diseases Society of America and the Adult AIDS Clinical Trials Group recommend pravastatin or atorvastatin in this setting, in the current study pravastatin was inferior both to rosuvastatin and atorvastatin.
The study "raises the question of whether it's time for the IDSA guidelines to be updated for patients with HIV," Dr. Heidi Crane, one of the study's authors from the Harborview Medical Center and the University of Washington, told Reuters Health. Doctors, she added, "are probably overusing pravastatin."
The authors followed 700 adults who were treated for dyslipidemia at two HIV clinics; the median length of follow-up was 19 months. According to the December 28th online report in Clinical Infectious Diseases, 43% were prescribed atorvastatin, 40% pravastatin, and 14% rosuvastatin.
After 12 months of treatment, the total cholesterol of patients on pravastatin dropped an average of 25 mg/dL, compared to 43 mg/dL in patients on rosuvastatin (p = 0.004 compared to pravastatin) and 39 mg/dL in patients on atorvastatin (p < 0.001 compared to pravastatin). Low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein (non-HDL)-C levels both decreased significantly more in the rosuvastatin and atorvastatin groups compared to the pravastatin group.
Of all patients who received their initial statin for 12 months and for whom the authors had complete data, 71% met National Cholesterol Education Program goals for LDL-C levels and 62% met goals for non-HDL-C levels after a year of treatment. The odds of reaching NCEP goals for LDL-C levels after a year were higher with rosuvastatin (OR = 2.1; p = 0.03) or atorvastatin (OR = 2.1; p = 0.001) compared to pravastatin. Patients taking rosuvastatin also had higher odds of reaching non-HDL-C goals (OR = 2.3; p = 0.045).
Toxicity developed in 6.4% of cases and was similar for patients on each drug. The most common potentially serious toxicity was an elevation in creatine phosphokinase (CPK) levels.
Dr. Crane said that while some European guidelines have been updated to include rosuvastatin for HIV-positive patients, U.S. recommendations were written before it became a common drug.
Even so, with rosuvastatin showing success in the non-HIV population, doctors caring for patients with HIV have begun incorporating it into treatment, Dr. Crane said. "We're sort of following along" with the literature, she said. "And it's time to follow quicker."
Dr. Kristine Scordo, who heads the Acute Care Nurse Practitioner Program at Wright State University-Miami Valley College of Nursing and Health in Dayton, Ohio, and was not involved in the research, said the results with rosuvastatin are consistent with what she sees in clinical practice.
"Everybody knows that rosuvastatin is one of the most powerful drugs out there. What's in this article is a known fact," she told Reuters Health. "The guidelines need to be updated because rosuvastatin is a great drug. We all use it, but you won't find it in the guidelines."
Because many patients in the study did not reach NCEP goals, the authors also question whether combination lipid-lowering treatment may be necessary for patients with HIV.
The low toxicity rates for all three drugs are a good sign for statin therapy in this group in general, Dr. Crane said. "I think that the recommendations from this are: statins are safer than we may have thought, so rethink whether patients with elevated lipids should be treated with them," she said. But, "for many of these patients, they're not going to make their targets on pravastatin, and so there should be some reconsideration of the type of statins used."
SOURCE:http://bit.ly/hERkJO
Clin Infect Dis Dec 2010.
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