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Cholesterol Treatment Patterns and Cardiovascular Clinical Outcomes Associated with Colesevelam HCl and Ezetimibe

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Abstract

Introduction

Pharmaceuticals are commonly used to help at-risk patients reduce low-density lipoprotein cholesterol (LDL-C) levels in an effort to prevent atherosclerotic coronary artery disease. Although both the cholesterol inhibitor ezetimibe and the newer generation bile acid sequestrant colesevelam hydrochloride (HCl) effectively reduce LDL-C levels in patients with hypercholesterolemia, real-world evidence based on clinical outcomes is lacking.

Methods

A retrospective analysis of healthcare insurance claims data from a large national healthcare payer was conducted to evaluate outcomes within 12 months among 2,067 patients with hypercholesterolemia after the initiation of treatment with colesevelam HCl (679 patients) as compared with ezetimibe (1,388 patients). Outcomes evaluated were (1) composite cardiovascular event which included myocardial infarction, stroke, angina, or revascularization and (2) macrovascular complication event which was a wider-encompassing measure that included all composite cardiovascular outcomes along with atherosclerosis, aneurysm, embolism, and peripheral vascular disease.

Results

An adjusted logistic regression model found lower odds of a composite cardiovascular event (odds ratio [OR] 0.54, 95 % confidence interval [CI] 0.30–0.97) within 12 months for subjects initiating treatment with colesevelam HCl compared with subjects initiating treatment with ezetimibe. The unadjusted OR was slightly lower (OR 0.52, 95 % CI 0.30–0.90). The odds ratio for the wider-encompassing macrovascular complication event occurring within 12 months of initiating treatment with colesevelam HCl or ezetimibe was not statistically significant (OR 0.821, 95 % CI 0.49–1.35).

Discussion

The evidence of lower risk for composite cardiovascular event rates for subjects treated with colesevelam HCl compared with those treated with ezetimibe suggests the potential need to consider risk of clinical outcomes, in addition to LDL-C levels, in real-world practice when choosing a pharmaceutical treatment.

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Acknowledgments

We thank Sam Ye, PhD, for contributions to the study design and interpretation of the results and Feride Frech-Tamas, PhD, for contributions to the finalization of this manuscript. We also thank Mary Costantino, PhD, a full-time employee of Comprehensive Health Insights, Inc., who was paid for contributions to this manuscript, and for reviewing and editing this manuscript. This research was funded by Daiichi Sankyo Pharmaceuticals. Daiichi Sankyo manufactures and markets colesevelam HCl. Phil Schwab and Anthony Louder are employees of Comprehensive Health Insights, which received funding from Daiichi Sankyo for data access fees and research consulting services. Yong Li was an employee of Comprehensive Health Insights at the time of study execution. Dr. Harold Bays received funding from Daiichi Sankyo as a medical and research consultant. Sam Ye and Feride Frech-Tamas are employees and shareholders of Daiichi Sankyo. Rajiv Mallick was an employee of Daiichi Sankyo at the time of study execution.

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Authors and Affiliations

  1. Comprehensive Health Insights Inc., a Humana Company, 325 W. Main St., WFP6W, 40202, Louisville, KY, USA

    Philip Schwab & Yong Li

  2. Comprehensive Health Insights Inc., a Humana Company, 40202, Louisville, KY, USA

    Anthony Louder

  3. Daiichi Sankyo, Parsippany, NJ, USA

    Rajiv Mallick

  4. Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA

    Harold Bays

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  1. Philip Schwab
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Correspondence to Philip Schwab.

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Schwab, P., Louder, A., Li, Y. et al. Cholesterol Treatment Patterns and Cardiovascular Clinical Outcomes Associated with Colesevelam HCl and Ezetimibe. Drugs Aging 31, 683–694 (2014). https://doi.org/10.1007/s40266-014-0200-6

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