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De effecten van atorvastatine op een rij
Datum: 26.02.2013
Atorvastatine is een statine die in de NHG-standaard in aanmerking komt wanneer met simva- of pravastatine de streefwaarde niet wordt gehaald. In de onderstaande studie zijn 254 studies op een rij gezet naar de effectiviteit van dit middel. Atorvastatine geeft dalingen van het totale cholesterol, het LDL-cholesterol en de triglyceriden, en er is hierbij sprake van een dosis-afhankelijk effect. Als beperking van hun studie geven de auteurs aan dat de meeste studie een te korte duur hadden om een goed beeld te geven van de bijwerkingen. Bijwerkingen werden zelfs niet genoemd in 37% van de placebo-gecontroleerde studies. 

Bron: Cochrane Database Syst Rev. 2012 Dec 12;12:CD008226.


Lipid lowering efficacy of atorvastatin.

Adams SP, Tsang M, Wright JM.


Abstract
BACKGROUND:
Atorvastatin is one of the most widely prescribed drugs and the most widely prescribed statin in the world. It is therefore important to know the dose-related magnitude of effect of atorvastatin on blood lipids.

OBJECTIVES:
To quantify the dose-related effects of atorvastatin on blood lipids and withdrawals due to adverse effects (WDAE).

SEARCH METHODS:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 4, 2011, MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), ISI Web of Science (1899 to November 2011) and BIOSIS Previews (1969 to November 2011). No language restrictions were applied.

SELECTION CRITERIA:
Randomised controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of atorvastatin on blood lipids over a duration of 3 to 12 weeks.

DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed trial quality and extracted data. WDAE information was collected from the placebo-controlled trials.

MAIN RESULTS:
Two hundred fifty-four trials evaluated the dose-related efficacy of atorvastatin in 33,505 participants. Log dose-response data revealed linear dose-related effects on blood total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides. Combining all the trials using the generic inverse variance fixed-effect model for doses of 10 to 80 mg/day resulted in decreases of 36% to 53% for LDL-cholesterol. There was no significant dose-related effects of atorvastatin on blood high-density lipoprotein (HDL)-cholesterol. WDAE were not statistically different between atorvastatin and placebo for these short-term trials (risk ratio 0.99; 95% confidence interval 0.68 to 1.45).

AUTHORS' CONCLUSIONS:
Blood total cholesterol, LDL-cholesterol and triglyceride lowering effect of atorvastatin was dependent on dose. Log dose-response data was linear over the commonly prescribed dose range. Manufacturer-recommended atorvastatin doses of 10 to 80 mg/day resulted in 36% to 53% decreases of LDL-cholesterol. The review did not provide a good estimate of the incidence of harms associated with atorvastatin because of the short duration of the trials and the lack of reporting of adverse effects in 37% of the placebo-controlled trials.