COMBINED TREATMENT OF RESISTANT HYPERCHOLESTEROLEMIA BY LDL-APHERESIS, STATIN AND EZETIMIBE

Background: Treatment with extracorporeal elimination technique - LDL (low-density lipoprotein)-apheresis (LA), or combined therapy of ezetimibe with HMG-CoA reductase inhibitor (statin) is indicated in patients with resistant heterozygote [FH] or homozygote [HoFH]) familial hypercholesterolemia. Experience concerning the use of ezetimibe in combination with LDL-apheresis is limited.
Methods: Patient with resistant hypercholesterolemia (n=11, 5 women, 6 men, age 21-60 y, among them patients with HoFH n=3) were treated by diet, statin (simvastatin 40mg or atorvastatin 40-80mg daily) and LA. Cell-free plasma has been sampled after centrifugation by Cobe-Spectra. LA was performed using a) cascade filtration (filters Evaflux 4A, Kuraray®, n=4) or b) LDL-immunoadsorption (filters Pockard®, n=7). The effect of combined treatment by ezetimibe (Ezetrol® 10mg daily) was evaluated after 1, 6 and 12 months.
Results: Combined treatment with ezetimibe enabled to reach lower serum LDL-cholesterol after each of LA (1,15+0,89 vs 0,81+0,38 mmol/l). Ezetimibe treatment after 12 months combined by LA and statin significantly decreased serum LDL-cholesterol (-20,6%). Treatment was effective even in two HoFH patiens. Two patients (1x HoFH, 1x FH) did not respond to ezetimibe therapy. Among them, one FH patient was extra cholesterol synthesizer, and a defective response to ezetimebe is supposed in the other HoFH individua.
Conclusion: A combined treatment with ezetimibe and statin should be used in responding patiens with severe hypercholesterolemia treated by LDL-apheresis.

Supported by research projects IGA MH CR NR/8497-3, 1A/8689-4.