Comparative Effectiveness of Ezetimibe in Improving Lipid Profile in Non-Alcoholic Fatty Liver Disease Patients: Statins Still Rule

Introduction: Dyslipidemias are well-documented disorders in nonalcoholic fatty liver disease (NAFLD) patients; and have been implicated as an etiology and prognosis factor for the disease, as well. In the current study, we aimed to evaluate the impact of various antihyperlipidemic regimens on the serum cholesterol levels.

Method and material: A longitudinally study was conducted and 98 NAFLD patients were consecutively entered into analysis. Five types of antihyperlipidemic regimens were used: Ezetimibe alone (10mg/day; 3 patients); Ezetimibe (10mg/day) plus gemfibrozil (600mg/day) (28 patients); Gemfibrozil alone (600mg/day; 26 patients); Atorvastatin (20mg/day; 15 patients); and Simvastatin (20mg/day; 26 patients).

Results: patients were followed for 138±83 days after drugs administered. Serum total cholesterol levels experiences highest fall by atorvastatin therapy (p=0.006). Serum LDL levels also decreased most significantly through antihyperlipidemic therapy with atorvastatin or simvastatin (p<0.001). There was no difference between the study drug regimens modifying serum HDL, triglyceride, AST and ALT levels (p>0.1 for all).

Conclusion: Ezetimibe therapy alone cannot improve hyperlipidemias in NAFLD patients, while statins, especially atorvastatin is highly potent for this purpose; and is recommended for hyperlipidemic NAFLD patients. For NAFLD patients who have unfavorable reactions to statins and are subjected to use ezetimibe, we recommend its co-administration with gemfibrozil. Future studies with randomized and blind approaches are needed.