Comparison of Hmg-Coa Reductase Inhibitors

A systematic review 1 including 10 RCTs comparing the efficacy of HMG-CoA reductase inhibitors was abstracted in DARE.

Two trials found that lovastatin and pravastatin are approximately equipotent on a milligram-for-milligram basis.

Two trials found that simvastatin is at least twice as effective per milligram of drug than lovastatin.

Four trials found that simvastatin was more effective per milligram than pravastatin (10 mg/d reduced LDL cholesterol concentration by 28% which was greater than the 25% reduction found in those patients treated with 20 mg/day pravastatin).

Two trials compared lovastatin with fluvastatin and found that lovastatin reduced LDL cholesterol by 26.9% at 20 mg/d as compared with 18.0% for fluvastatin.

The side effects of the four drugs were similar.

Another review 2 abstracted in DAREincluded 12 comparative trials with a total of 3261 patients. Simvastatin was twice as potent as lovastatin and pravastatin. The hypocholesterolaemic effect of fluvastatin appears to be approximately 30% less than that of lovastatin. In post-transplant patients receiving cyclosporin, safety has been documented for low doses of lovastatin and simvastatin, but when a higher dosage of an HMG-CaA reductase inhibitor is warranted, pravastatin should be considered the drug of choice because of a lower incidence of myopathy.

Comment: Atorvastatin and rosuvastatin were not included in these reviews that were published in 1994 and 1995.

References

• Illingworth DR, Tobert JA. A review of clinical trials comparing HMG-CoA reductase inhibitors. Clin Ther 1994 May-Jun;16(3):366-85; discussion 365. [PubMed][DARE]
• Hsu I, Spinler SA, Johnson NE. Comparative evaluation of the safety and efficacy of HMG-CoA reductase inhibitor monotherapy in the treatment of primary hypercholesterolemia. Ann Pharmacother 1995 Jul-Aug;29(7-8):743-59. [PubMed] [DARE]