Atorvastatin Every Other Day as Effective as Daily Dose in Lowering Cholesterol

Laurie Barclay, MD

October 25, 2002

Oct. 25, 2002 — Giving atorvastatin every other day was as effective in lowering low-density lipoprotein cholesterol (LDL-C) levels as giving it daily, according to a pilot study reported in the October issue of the American Heart Journal. The mean dose was higher but the average daily dose was lower, resulting in cost savings.

"The average monthly cost for each 1% reduction in LDL-C resulted in annualized cost savings of $269 per patient for the alternate-day group," write Mazen S. Matalka, PharmD, from the Veterans Administration Central California Health Care System in Fresno, and colleagues.

In the Alternate Day Versus Daily Dosing of Atorvastatin Study (ADDAS), a double-blind, placebo-controlled pilot study, 35 eligible patients who met National Cholesterol Education Program (NCEP) Adult Treatment Panel II (ATP II) guidelines for drug therapy were randomized to treatment with 10 mg of atorvastatin as an initial dose daily or every other day. At six and 12 weeks, the dose was doubled in patients who had not met the LDL-C goal.

At six weeks, LDL-C levels decreased by 27% in the alternate-day group and by 38% in the daily group. At 12 weeks, LDL-C levels decreased by 35% in the alternate-day and by 38% in the daily group ( P=.49). More patients achieved their LDL-C goal in the daily group than in the alternate-day group (75% vs. 43%). Mean dose was 18 mg (9 mg/d) in the alternate-day group (n=14) and 12 mg/d in the daily group (n=12) at the end of the 12-week study ( P=.001).

Study limitations include inadequate study period to titrate the dose to achieve the LDL-C goal, small sample size, and high dropout rate.

"Although higher doses of atorvastatin were used on alternate days, these results suggest that the alternate-day administration of atorvastatin can produce a reduction in LDL-C comparable to that of daily administration in patients with hypercholesterolemia, and yet provide some cost savings," the authors write. "Larger randomized clinical trials should be conducted to evaluate the compliance and cost-effectiveness of the alternate-day versus daily administration of atorvastatin in the clinical setting."

Am Heart J. 2002;144:674-677

Reviewed by Gary D. Vogin, MD