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Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

General Research Article

A Multicenter Prospective Hospital-based Cohort Study on the Efficacy and Safety of Pitavastatin

Author(s): Abdullah Shehab*, Asim Ahmed Elnour, Akshaya Srikanth Bhagavathula, Joseph Pulavelil Kurian, Gazi Hassan, Shareen AlZaabi, Huburt Gilbert and Khalid Al-Rasadi

Volume 17, Issue 7, 2021

Published on: 28 December, 2020

Article ID: e122820189541 Pages: 9

DOI: 10.2174/1573399817666201228164243

Abstract

Aims: We aim to investigate the efficacy and safety of pitavastatin 4 mg in a population of people living in the United Arab Emirates (UAE).

Background: Pitavastatin is a member of the HMG-CoA reductase inhibitors family which was approved for use in adult subjects with primary hyperlipidemia or mixed dyslipidemia. To date, no published studies have assessed the efficacy and safety of pitavastatin in the United Arab Emirates.

Objective: The main objective of the current study was to investigate the efficacy and safety of pitavastatin in subjects with dyslipidemia for the primary prevention of cardiovascular diseases based on total cardiovascular risk.

Methods: This was a multicentre (four private hospitals) prospective cohort study to analyze data on the use of pitavastatin for dyslipidemia in adult outpatients in Abu Dhabi and Dubai, United Arab Emirates. We have followed up the clinical profiles of subjects in four hospitals for six-weeks during the period from June 2015 to June 2017. Efficacy was based on the evaluation of the mean (± standard deviation) change in low-density lipoprotein cholesterol between baseline and week six after the initiation of pitavastatin therapy. Safety was reported with respect to the incidence of adverse events occurring with the use of pitavastatin and the development of new-onset diabetes.

Results: A total of 400 subjects who were receiving pitavastatin 4 mg were included. The mean age of subjects was 50.7 ±10.8 years; of these, 79.0% were males. At the baseline, the mean level of total cholesterol was 185.4 ±41.5 mg/dL, low density lipoprotein was 154.9 ±48.55 mg/dL, high- -density lipoprotein cholesterol was 40.5 ±11.23 mg/dL and fasting blood glucose was 115.0 (±16.63) mg/dl. At the end of six weeks, low density lipoprotein levels significantly decreased to 112.09 ±41.90 mg/dl (standard mean difference (SMD) (-42.8%), 95% CI: -42.88 [-49.17 to -36.58] mg/dl, P <0.001), while high density lipoprotein levels improved (SMD, 95% CI: 1.77% [0.25 to 3.28] mg/dl, P <0.022). There were 55 subjects (13.7%) who reported various adverse events such as myalgia (7.5%), sleep disorders (2.5%), and myopathy (2.2%). Furthermore, 4 (1.0%) have had developed new-onset diabetes post-six-weeks of initiation of pitavastatin therapy.

Conclusion: Pitavastatin 4 mg showed robust efficacy in reducing LDL-C levels and improving HDL-C levels in subjects with dyslipidemia. The use of pitavastatin was associated with a low discontinuation rate, fewer adverse events, and very limited cases of new-onset diabetes.

Keywords: Dyslipidemia, efficacy, low density lipoprotein (LDL-C), multicenter, new-onset diabetes, pitavastatin.

[1]
Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Executive summary of The third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001; 285(19): 2486-97.
[http://dx.doi.org/10.1001/jama.285.19.2486] [PMID: 11368702]
[2]
Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364(9438): 937-52.
[http://dx.doi.org/10.1016/S0140-6736(04)17018-9] [PMID: 15364185]
[3]
Baigent C, Keech A, Kearney PM, et al. Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366(9493): 1267-78.
[http://dx.doi.org/10.1016/S0140-6736(05)67394-1] [PMID: 16214597]
[4]
Baigent C, Blackwell L, Emberson J, et al. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376(9753): 1670-81.
[http://dx.doi.org/10.1016/S0140-6736(10)61350-5] [PMID: 21067804]
[5]
Stone NJ, Robinson JG, Lichtenstein AH, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63(25 Pt B): 2889-934.
[http://dx.doi.org/10.1016/j.jacc.2013.11.002] [PMID: 24239923]
[6]
Catapano AL, Graham I, De Backer G, et al. ESC Scientific Document Group. 2016 ESC/EAS guidelines for the management of dyslipidemias. Eur Heart J 2016; 37(39): 2999-3058.
[http://dx.doi.org/10.1093/eurheartj/ehw272] [PMID: 27567407]
[7]
Al Sifri SN, Almahmeed W, Azar S, et al. Results of the Dyslipidemia International Study (DYSIS)-Middle East: clinical perspective on the prevalence and characteristics of lipid abnormalities in the setting of chronic statin treatment. PLoS One 2014; 9(1): e84350.
[http://dx.doi.org/10.1371/journal.pone.0084350] [PMID: 24400085]
[8]
Al-Hashmi K, Al-Zakwani I, Al Mahmeed W, et al. Non-high-density lipoprotein cholesterol target achievement in patients on lipid-lowering drugs and stratified by triglyceride levels in the Arabian Gulf. J Clin Lipidol 2016; 10(2): 368-77.
[http://dx.doi.org/10.1016/j.jacl.2015.12.021] [PMID: 27055968]
[9]
Al-Zakwani I, Al-Mahruqi F, Al-Rasadi K, et al. Sex disparity in the management and outcomes of dyslipidemia of diabetic patients in the Arabian Gulf: findings from the CEPHEUS study. Lipids Health Dis 2018; 17(1): 25.
[http://dx.doi.org/10.1186/s12944-018-0667-y] [PMID: 29402296]
[10]
Shehab A, Al-Rasadi K, Arafah M, et al. The management of dyslipidaemia in patients with type 2 diabetes mellitus receiving lipid-lowering drugs: a sub-analysis of the CEPHEUS findings. Curr Vasc Pharmacol 2018; 16(4): 368-75.
[http://dx.doi.org/10.2174/1570161115666170705153815] [PMID: 28677510]
[11]
Adams SP, Alaeiilkhchi N, Wright JM. Pitavastatin for lowering lipids Cochrane Database of systemartic reviews 2017; 7: CD012735.
[http://dx.doi.org/10.1002/14651858.CD012735]
[12]
Pirillo A, Catapano AL. Pitavastatin and HDL: Effects on plasma levels and function(s). Atheroscler Suppl 2017; 27: e1-9.
[http://dx.doi.org/10.1016/j.atherosclerosissup.2017.05.001] [PMID: 28716185]
[13]
Boekholdt SM, Arsenault BJ, Mora S, et al. Association of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B levels with risk of cardiovascular events among patients treated with statins: a meta-analysis. JAMA 2012; 307(12): 1302-9.
[http://dx.doi.org/10.1001/jama.2012.366] [PMID: 22453571]
[14]
Teramoto T, Shimano H, Yokote K, Urashima M. Effects of pitavastatin (LIVALO Tablet) on high density lipoprotein cholesterol (HDL-C) in hypercholesterolemia. J Atheroscler Thromb 2009; 16(5): 654-61.
[http://dx.doi.org/10.5551/jat.1719] [PMID: 19907105]
[15]
Ose L, Budinski D, Hounslow N, Arneson V. Long-term treatment with pitavastatin is effective and well tolerated by patients with primary hypercholesterolemia or combined dyslipidemia. Atherosclerosis 2010; 210(1): 202-8.
[http://dx.doi.org/10.1016/j.atherosclerosis.2009.12.009] [PMID: 20080236]
[16]
Teramoto T, Shimano H, Yokote K, Urashima M. New evidence on pitavastatin: efficacy and safety in clinical studies. Expert Opin Pharmacother 2010; 11(5): 817-28.
[http://dx.doi.org/10.1517/14656561003641990] [PMID: 20201733]
[17]
Hoy SM. Pitavastatin: a review in hypercholesterolemia. Am J Cardiovasc Drugs 2017; 17(2): 157-68.
[http://dx.doi.org/10.1007/s40256-017-0213-8] [PMID: 28130659]
[18]
Stender S, Hounslow N. Robust efficacy of pitavastatin and comparable safety to pravastatin. Atheroscler Suppl 2009; 10: 770.
[http://dx.doi.org/10.1016/S1567-5688(09)70926-2]
[19]
Stone NJ, Robinson JG, Lichtenstein AH, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(25)(Suppl. 2): S1-S45.
[http://dx.doi.org/10.1161/01.cir.0000437738.63853.7a] [PMID: 24222016]
[20]
Reiner Z, Catapano AL, De Backer G, et al. European Association for Cardiovascular Prevention & Rehabilitation; ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. ESC/EAS guidelines for the management of dyslipidemias: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32(14): 1769-818.
[http://dx.doi.org/10.1093/eurheartj/ehr158] [PMID: 21712404]
[21]
Centre for drug evaluation and research US Food and Drug Administration https://www.accessdata.fda.gov/drugsatfda_docs/nda/2009/022363s000_MedR_P1.pdf2017.
[22]
Saito Y, Yamada N, Teramoto T, et al. Clinical efficacy of pitavastatin, a new 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, in patients with hyperlipidemia. Dose-finding study using the double-blind, three-group parallel comparison. Arzneimittelforschung 2002; 52(4): 251-5.
[PMID: 12040967]
[23]
Rohatgi A, Khera A, Berry JD, et al. HDL cholesterol efflux capacity and incident cardiovascular events. N Engl J Med 2014; 371(25): 2383-93.
[http://dx.doi.org/10.1056/NEJMoa1409065] [PMID: 25404125]
[24]
Subedi BH, Joshi PH, Jones SR, Martin SS, Blaha MJ, Michos ED. Current guidelines for high-density lipoprotein cholesterol in therapy and future directions. Vasc Health Risk Manag 2014; 10: 205-16.
[PMID: 24748800]
[25]
Otvos JD, Guyton JR, Connelly MA, et al. Relations of GlycA and lipoprotein particle subspecies with cardiovascular events and mortality: A post hoc analysis of the AIM-HIGH trial. J Clin Lipidol 2018; 12(2): 348-355.e2.
[http://dx.doi.org/10.1016/j.jacl.2018.01.002] [PMID: 29409728]
[26]
Maruyama T, Takada M, Nishibori Y, et al. Comparison of preventive effect on cardiovascular events with different statins. -The CIRCLE study-. Circ J 2011; 75(8): 1951-9.
[http://dx.doi.org/10.1253/circj.CJ-10-1163] [PMID: 21673458]
[27]
Yokote K, Bujo H, Hanaoka H, et al. Multicenter collaborative randomized parallel group comparative study of pitavastatin and atorvastatin in Japanese hypercholesterolemic patients: collaborative study on hypercholesterolemia drug intervention and their benefits for atherosclerosis prevention (CHIBA study). Atherosclerosis 2008; 201(2): 345-52.
[http://dx.doi.org/10.1016/j.atherosclerosis.2008.02.008] [PMID: 18472103]
[28]
Poolsup N, Suksomboon N, Wongyaowarat K, Rungkanchananon B, Niyomrat P, Kongsuwan S. Meta-analysis of the comparative efficacy and safety of pitavastatin and atorvastatin in patients with dyslipidaemia. J Clin Pharm Ther 2012; 37(2): 166-72.
[http://dx.doi.org/10.1111/j.1365-2710.2011.01274.x] [PMID: 21585411]
[29]
Verdoia M, Nardin M, Sartori C, et al. Novara Atherosclerosis Study Group (NAS). Impact of atorvastatin or rosuvastatin co-administration on platelet reactivity in patients treated with dual antiplatelet therapy. Atherosclerosis 2015; 243(2): 389-94.
[http://dx.doi.org/10.1016/j.atherosclerosis.2015.10.005] [PMID: 26520891]
[30]
Ovrakh T, Serik S, Kochubiei O. Impact of atorvastatin and rosuvastatin on residual on-clopidogrel treatment platelet reactivity in patients with ischemic heart disease and type 2 diabetes mellitus after acute coronary syndrome. Georgian Med News 2017; (265): 7-14.
[PMID: 28574378]
[31]
Godino C, Pavon AG, Mangieri A, et al. Platelet reactivity in response to loading dose of atorvastatin or rosuvastatin in patients with stable coronary disease before percutaneous coronary intervention: The STATIPLAT randomized study. Clin Cardiol 2017; 40(8): 605-11.
[http://dx.doi.org/10.1002/clc.22709] [PMID: 28422300]
[32]
Teramoto T. The clinical impact of pitavastatin: comparative studies with other statins on LDL-C and HDL-C. Expert Opin Pharmacother 2012; 13(6): 859-65.
[http://dx.doi.org/10.1517/14656566.2012.660525] [PMID: 22332608]
[33]
Nagasawa SY, Okamura T, Iso H, et al. Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN) Research Group. Relation between serum total cholesterol level and cardiovascular disease stratified by sex and age group: a pooled analysis of 65 594 individuals from 10 cohort studies in Japan. J Am Heart Assoc 2012; 1(5): e001974.
[http://dx.doi.org/10.1161/JAHA.112.001974] [PMID: 23316288]
[34]
Peters SA, Singhateh Y, Mackay D, Huxley RR, Woodward M. Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. Atherosclerosis 2016; 248: 123-31.
[http://dx.doi.org/10.1016/j.atherosclerosis.2016.03.016] [PMID: 27016614]
[35]
Jeong SM, Choi S, Kim K, et al. Effect of change in Total cholesterol levels on cardiovascular disease among young adults. J Am Heart Assoc 2018; 7(12)
[http://dx.doi.org/10.1161/JAHA.118.008819] [PMID: 29899019]
[36]
Taguchi I, Iimuro S, Iwata H, et al. Highdose versus low-dose pitavastatin in Japanese patients with stable coronary artery disease (REAL-CAD): a randomized superiority trial. Circulation 2018; 137(19): 1997-2009.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.117.032615] [PMID: 29735587]
[37]
Ridker PM. Moving toward new statin guidelines in a post-JUPITER world: principles to consider. Curr Atheroscler Rep 2009; 11(4): 249-56.
[http://dx.doi.org/10.1007/s11883-009-0039-1] [PMID: 19500487]
[38]
Preiss D, Seshasai SR, Welsh P, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011; 305(24): 2556-64.
[http://dx.doi.org/10.1001/jama.2011.860] [PMID: 21693744]
[39]
Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375(9716): 735-42.
[http://dx.doi.org/10.1016/S0140-6736(09)61965-6] [PMID: 20167359]
[40]
Crandall JP, Mather K, Rajpathak SN, et al. Statin use and risk of developing diabetes: results from the Diabetes Prevention Program. BMJ Open Diabetes Res Care 2017; 5(1): e000438.
[http://dx.doi.org/10.1136/bmjdrc-2017-000438] [PMID: 29081977]
[41]
Eriksson M, Budinski D, Hounslow N. Long-term efficacy of pitavastatin versus simvastatin. Adv Ther 2011; 28(9): 799-810.
[http://dx.doi.org/10.1007/s12325-011-0057-6] [PMID: 21874537]
[42]
Chamberlin KW, Baker WL. Benefit-risk assessment of pitavastatin for the treatment of hypercholesterolemia in older patients. Clin Interv Aging 2015; 10: 733-40.
[PMID: 25931816]
[43]
Gumprecht J, Gosho M, Budinski D, Hounslow N. Comparative long-term efficacy and tolerability of pitavastatin 4 mg and atorvastatin 20-40 mg in patients with type 2 diabetes mellitus and combined (mixed) dyslipidaemia. Diabetes Obes Metab 2011; 13(11): 1047-55.
[http://dx.doi.org/10.1111/j.1463-1326.2011.01477.x] [PMID: 21812889]
[44]
Jiang Z, Gong RR, Qiu L, et al. Efficacy and safety of pitavastatin versus simvastatin: a meta-analysis of randomized controlled trials. Clin Drug Investig 2014; 34(9): 599-608.
[http://dx.doi.org/10.1007/s40261-014-0215-0] [PMID: 25022719]
[45]
Shehab A, Bhagavathula AS, Elnour AA, Al-Rasadi K, Al-Shamsi S. The incidence of adverse drug reactions in patients treated with statins in the emirates: A retrospective cohort study. Curr Vasc Pharmacol 2020; 18(2): 193-9.
[http://dx.doi.org/10.2174/1570161117666190408164908] [PMID: 30963975]

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