Efficacy and tolerability of multidrug therapy for hypertriglyceridemia
Venkateshwar R. Polsani,
Salim S. Virani,
Eric Y. Yang,
Peter H. Jones
Christie M. Ballantyne
Although there is clinical evidence for the safety and efficacy of single-drug therapy and some two-drug combinations for the treatment of hypertriglyceridemia, information is limited on the use of more than 2 drugs.
We evaluated the efficacy and safety of multidrug regimens (≥3 agents) in the management of hypertriglyceridemia.
The study included 40 individuals in an academic lipid referral clinic with mean follow-up of 1.98 years and an average use of 3.5 medications.
During the study, mean body mass index decreased significantly (P=.0127), from 29.2 kg/m2 to 28.7 kg/m2, and mean hemoglobin A1C showed a trend towards decreasing (P=.06), from 7.9% to 7.2% in patients with diabetes (n=17). All lipid parameters decreased significantly: total cholesterol level decreased significantly from (mean±SD) 334.3±282.9 mg/dL to 183.8±54.8 mg/dL (P=.001, mean reduction of 45%), mean (± SD) triglyceride level decreased significantly from 1900.9±4576.8 mg/dL to 300.7±372.2 mg/dL (P=.02), median (range) triglyceride level decreased from 599 (242-28,550) mg/dL to 301 (40-1960) mg/dL (P < .001, mean reduction of 50%), and mean (± SD) non-high-density lipoprotein cholesterol decreased significantly from 189.9±131.6 mg/dL to 138.4±49.1 mg/dL (P=.014, mean reduction of 27%). There were no serious adverse effects (rhabdomyolysis or increased liver function tests >3 times upper limit of normal).
In a 2-year follow-up of 40 individuals on multidrug therapy (average of 3.5 drugs) for severe hypertriglyceridemia, combination therapy was efficacious and well tolerated.