Treatment adherence, persistence, and effectiveness of fixed dose combination versus free combination therapy of rosuvastatin–ezetimibe as a lipid-lowering therapy
Bibliographic record
Abstract
Background: Guidelines for dyslipidemia management recommend adding ezetimibe for patients with dyslipidemia inadequately controlled with statin monotherapy. A fixed-dose combination (FDC) of statin and ezetimibe may improve persistence and adherence and hence reduce LDL-C further compared to free-combination treatment (FCT). The primary aim was to compare persistence/adherence with FDC versus FCT of rosuvastatin and ezetimibe (R/E); the secondary aim was to assess the impact of treatment adherence and persistence to LDL-C percentage reduction from baseline. An exploratory analysis assessed the impact of treatment adherence and persistence to incidence of major adverse cardiovascular events (MACEs). A subgroup analysis of patients on FDC of rosuvastatin 10 mg and ezetimibe 10 mg was also conducted. Methods: A retrospective analysis was performed using the THIN® database from Belgium and France in individuals (aged ≥18 years who received R/E as FDC or FCT between January 01, 2017, and November 30, 2022). Persistence (time from landmark date to discontinuation, with the latter defined as >45 days gap between prescription fills) and adherence (having a proportion of days covered ≥80%) were defined. Subsequent analyses adopted propensity score matching or weighting, followed by Cox and logistic regression models. Results: A total of 15,643 treatment episodes (FDC: 11,300; FCT: 4,343) were selected. FDC R/E was associated with greater persistence (HR: 0.54, 95% CI: 0.51-0.58) and higher odds of adherence (OR: 3.00, 95% CI: 2.70-3.30) than FCT R/E. Based on the regression analysis results, patients who were persistent to treatment had a 10% higher reduction in LDL-C values from baseline than those non persistent. Similarly, patients who were adherent had 9.6% higher reduction in LDL-C levels from baseline than those not adherent. No significant difference was observed in association between persistence/adherence and MACEs. A consistent trend was also observed in the subgroup analysis. Conclusions: In conclusion, FDC of R/E use was associated with higher treatment persistence and adherence than FCT of R/E. Patients persistent/adherent to treatment had greater LDL-C reductions than those who discontinued or did not follow treatment schedule. The limited number of MACEs suggests a cautious interpretation of exploratory MACE findings.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".