Ezetimibe, a synthetic
2-azetidinone, is the first of a new class of compounds that selectively inhibits the absorption of
cholesterol and related
plant sterols in the intestine. The
drug, and its glucuronyl metabolite, are thought to inhibit a putative
cholesterol transporter of enterocytes, located within the brush-border membrane of the small intestine. In large, randomized, placebo-controlled, 12-week trials,
ezetimibe reduced levels of
low density lipoprotein-cholesterol (
LDL-C) by approximately 18%;
triglyceride levels were reduced by approximately 6% in one trial but not another.
Ezetimibe produced a modest increase in levels of
high density lipoprotein-cholesterol. Moreover, reductions in
LDL-C and
triglyceride levels were greater in patients treated with
ezetimibe coadministered with a
statin (
lovastatin,
pravastatin,
atorvastatin or
simvastatin), than with either of those agents given alone. The coadministration of the lowest
statin dose and
ezetimibe produced similar
LDL-C reductions to the administration of the highest
statin dose alone.
Ezetimibe also provided beneficial effects on plasma
lipid levels when administered to patients with
hypercholesterolemia already receiving a
statin.
Ezetimibe plus a
statin reduced
LDL-C levels more than the maximum
statin dose alone in a trial in patients with
homozygous familial hypercholesterolemia and was effective in a placebo-controlled trial in patients with homozygous
sitosterolemia. The
drug was well tolerated in clinical studies conducted to date. In large, randomized, double-blind trials,
ezetimibe had a similar tolerability profile to that of placebo. Coadministration of
ezetimibe and a
statin did not increase the incidence of adverse events related to
statin monotherapy.