Cerivastatin,a New Potent Synthetic HMG Co-A Reductase Inhibitor: Effect of 0.2 mg Daily in Subjects With Primary Hypercholesterolemia

Abstract

Background: Reduction of serum cholesterol, most notably low-density lipoprotein choles terol is associated with reductions in cardiovascular morbidity and mortality. Statins have been shown to effectively reduce low-density lipoprotein cholesterol via inhibition of the hydroxymethyl-coenzyme A (HMG-CoA) reductase. Cerivastatin is the most potent HMG- CoA reductase inhibitor currently under study in the United States.

Methods and Results: A parallel group, randomized, placebo-controlled, double-blind, mul ticenter study was conducted to compare the efficacy and safety of three different dosing reg imens of 0.2 mg/day of cerivastatin, a new HMG-CoA reductase inhibitor, in patients with hypercholesterolemia. After a 10-week diet-placebo lead-in period, 319 patients with low- density lipoprotein cholesterol >160 mg/dL were randomized to 4 weeks of treatment with one of the following regimens: cerivastatin 0.1 mg twice daily, cerivastatin 0.2 mg once daily with the evening meal, cerivastatin 0.2 mg once daily at bedtime or placebo. All three active treatment groups produced statistically significant (P < .05) changes compared to baseline and placebo in total cholesterol (0.1 mg twice daily -18.9%; 0.2 mg once daily with the evening meal: -21.9%; 0.2 mg once daily at bedtime: -22.1%; placebo: 0.0%), low-density lipoprotein cholesterol (0.1 mg twice daily: -25.7%; 0.2 mg once daily with the evening meal: -29.4%; 0.2 mg once daily at bedtime: -30.4%; placebo: 1.4%) and high-density lipoprotein cholesterol (0.1 mg twice daily: 5.3%; 0.2 mg once daily with the evening meal: 2.3%; 0.2 mg once daily at bedtime: 3.2%; placebo: -1.2%). Triglycerides, compared to baseline and placebo, were also reduced by all active treatments (0.1 mg twice daily: -11.6% [P = .05]; 0.2 mg once daily with the evening meal: -11.6% [P = .05]; and 0.2 mg at bed time: -10.9% [P = .07]). The percentage change in total cholesterol and low-density lipopro tein cholesterol after 4 weeks of therapy for the once-daily cerivastatin groups was statisti cally significantly greater (P < .05) than the cerivastatin twice daily regimen. A treatment response was seen by 1 week of therapy and was maximal by 3 weeks. The drug was well tolerated in all three dosing regimens and resulted in no significant increase in biochemical or clinical side effects compared to placebo.

Conclusion: Cerivastatin is a novel, highly potent, well-tolerated HMG-CoA reductase inhibitor that produces low-density lipoprotein cholesterol reductions of approximately 30% when administered at 0.2 mg once a day in the evenings.