Efficacy and tolerability of multidrug therapy for hypertriglyceridemia

Background: Although there is clinical evidence for the safety and efficacy of single-drug therapy and some two-drug combinations for the treatment of hypertriglyceridemia, information is limited on the use of more than 2 drugs. Objective: We evaluated the efficacy and safety of multidrug regimens (≥3 agents) in the management of hypertriglyceridemia. Methods: The study included 40 individuals in an academic lipid referral clinic with mean follow-up of 1.98 years and an average use of 3.5 medications. Results: During the study, mean body mass index decreased significantly (P = .0127), from 29.2 kg/m² to 28.7 kg/m², and mean hemoglobin A1C showed a trend towards decreasing (P = .06), from 7.9% to 7.2% in patients with diabetes (n = 17). All lipid parameters decreased significantly: total cholesterol level decreased significantly from (mean ± SD) 334.3 ± 282.9 mg/dL to 183.8 ± 54.8 mg/dL (P = .001, mean reduction of 45%), mean (± SD) triglyceride level decreased significantly from 1900.9 ± 4576.8 mg/dL to 300.7 ± 372.2 mg/dL (P = .02), median (range) triglyceride level decreased from 599 (242-28,550) mg/dL to 301 (40-1960) mg/dL (P < .001, mean reduction of 50%), and mean (± SD) non-high-density lipoprotein cholesterol decreased significantly from 189.9 ± 131.6 mg/dL to 138.4 ± 49.1 mg/dL (P = .014, mean reduction of 27%). There were no serious adverse effects (rhabdomyolysis or increased liver function tests >3 times upper limit of normal). Conclusion: In a 2-year follow-up of 40 individuals on multidrug therapy (average of 3.5 drugs) for severe hypertriglyceridemia, combination therapy was efficacious and well tolerated.