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Rosuvastatin vs. protease inhibitor switching for hypercholesterolaemia: a randomized trial
F J Lee1,2, P Monteiro3, D Baker4
1Clinical Research Program, Centre for Applied Medical Research, St Vincent's Hospital, Sydney, NSW, Australia.
Insights
Rosuvastatin significantly lowered cholesterol in HIV patients compared to switching protease inhibitors. Rosuvastatin was more effective and better tolerated, offering a superior treatment option for hypercholesterolaemia.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Hypercholesterolaemia and elevated cardiovascular risk are common in adults with HIV-1 infection, particularly those on protease inhibitor (PI)-based therapy.
- Management of dyslipidemia in this population requires careful consideration of drug interactions and treatment efficacy.
Purpose of the Study:
- To compare the efficacy and safety of initiating rosuvastatin versus switching ritonavir-boosted protease inhibitors (PI/r) in HIV-1-infected adults with hypercholesterolaemia and increased cardiovascular risk.
- To evaluate changes in lipid profiles and adverse events associated with each treatment strategy.
Main Methods:
- An open-label, multicentre study randomized HIV-1-infected adults with controlled viral load and hypercholesterolaemia to receive either rosuvastatin 10 mg/day or a switch in their PI/r regimen.
- The primary endpoint was the change in total cholesterol at 12 weeks, with participants receiving standardized diet and exercise advice.
Main Results:
- Rosuvastatin treatment resulted in significantly greater reductions in total cholesterol (-21.4%) and low-density lipoprotein (LDL) cholesterol (-29.9%) compared to switching PI/r (-8.7% and -1.0%, respectively).
- While rosuvastatin showed greater reductions in total and LDL cholesterol, PI/r switching led to smaller decreases in very low-density lipoprotein cholesterol and triglycerides.
- Adverse events were more frequent with PI/r switching (10 events) than with rosuvastatin (1 event).
Conclusions:
- Initiating rosuvastatin 10 mg/day for 12 weeks is more effective in reducing total and LDL cholesterol in HIV-1-infected adults on PI/r therapy than switching PI/r regimens.
- Rosuvastatin was better tolerated and demonstrated a superior safety profile compared to switching PI/r in this patient cohort.
Objectives:
The aim of the study was to compare the efficacy and safety of rosuvastatin initiation with those of switching of ritonavir-boosted protease inhibitors (PI/rs) in HIV-1-infected adults with hypercholesterolaemia and increased cardiovascular risk scores.
Methods:
In this open-label, multicentre study, HIV-1-infected adults on PI/r-based therapy with viral load < 50 HIV-1 RNA copies/mL, fasting total cholesterol ≥ 5.5 mmol/L (both for ≥ 6 months) and elevated cardiovascular risk (Framingham score ≥ 8% or diabetes or family history), and not on lipid-lowering therapy, were randomized to open-label rosuvastatin 10 mg/day or to PI/r switching, both with standardized diet/exercise advice. The primary endpoint was change in total cholesterol at week 12 (intention to treat).
Results:
There were 43 participants (23 on rosuvastatin). Baseline characteristics were: mean [± standard deviation (SD)] age 55 (8.5) years, 42 (98%) male, 41 (95%) white race, and mean (± SD) total cholesterol 6.2 (1.2) mmol/L. At enrolment, PI/rs were lopinavir/ritonavir (n = 22; 51%), atazanavir/ritonavir (n = 12; 28%) and darunavir/ritonavir (n = 9; 21%). The commonest PI/r substitutes were raltegravir (n = 9; 45%) and rilpivirine (n = 4; 20%). All participants were adherent through to week 12. Rosuvastatin yielded greater declines than PI/r switching in total (- 21.4% vs. - 8.7%, respectively; P = 0.003) and low-density lipoprotein (- 29.9% vs. - 1.0%, respectively; P < 0.001) cholesterol, but smaller declines in very low-density lipoprotein cholesterol and triglycerides (P < 0.01). Cholesterol lowering was greater in participants on atazanavir/ritonavir or once-daily darunavir/ritonavir (vs. lopinavir/ritonavir). More study drug-related adverse events (mostly grade 1 nausea/diarrhoea; 10 vs. one, respectively; P = 0.001) occurred with PI/r switching than with rosuvastatin.
Conclusions:
In adults receiving a PI/r, rosuvastatin 10 mg/day for 12 weeks yielded larger decreases in total and low-density lipoprotein cholesterol than PI/r switching, and was better tolerated.
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