Safety and Efficacy of Ezetimibe in Patients With and Without Chronic Kidney Disease at a Pharmacist-Managed Clinic.

Background: Despite optimal statin therapy, many patients may be at increased cardiovascular risk if they do not meet their low-density lipoprotein (LDL) goals. Ezetimibe is used to lower LDL cholesterol and reduce cardiovascular events, yet it is underused in clinical practice, and its effectiveness and safety are not well studied in patients with and without chronic kidney disease (CKD).

Methods: This single-center, retrospective chart review sought to determine changes in LDL and non-high-density lipoprotein (non-HDL) levels and incidence of muscle-related adverse events (AEs) after addition of ezetimibe in patients without CKD. In addition, this study assessed changes in LDL and non-HDL levels and incidence of muscle-related AEs in patients with CKD. Data were obtained from the Computerized Patient Record System for patients prescribed ezetimibe by a patient aligned care team pharmacist at the Wilkes-Barre Veterans Affairs Medical Center.

Results: From September 1, 2021, through September 1, 2023, ezetimibe was initiated for 173 patients (36 patients with CKD and 137 without CKD). Patients without CKD had mean reductions in LDL and non-HDL levels of 23.5% and 21.7%, respectively. Patients with CKD had mean reductions in LDL and non-HDL levels of 27.0% and 24.8%, respectively. Muscle-related AEs occurred in 13.9% of patients in both groups.

Conclusions: A more pronounced reduction in mean LDL and non-HDL levels was seen with ezetimibe therapy than reported in the literature. Patients with CKD had greater reductions of LDL and non-HDL levels compared with patients without CKD, potentially due to increased accumulation. Muscle-related AEs did not differ between the groups, indicating that although ezetimibe accumulates more in patients with CKD, it was not correlated with increased risk of muscle-related AEs.