A review of current clinical findings with fluvastatin

Fluvastatin, the newest member of the class of 3-hydroxy-3-methylglutaryl-coenzyme a (HMG-CoA) reductase inhibitors, is structurally different from the fungal metabolites (lovastatin, pravastatin, and simvastatin) and is wholly synthetic. Fluvastatin has a distinct biopharmaceutical profile, including a short systemic exposure time (half-life of 1.2 hours) and virtually no active circulating metabolites. Fluvastatin is targeted to the liver, where it is rapidly metabolized; 98% of fluvastatin is protein bound. Double-blind, placebo-controlled studies have demonstrated that fluvastatin at daily dosages of 20-40 mg produces significant decreases from baseline in low-density lipoprotein (LDL) cholesterol on the order of 22-31% in patients with severe primary hypercholesterolemia (mean baseline LDL cholesterol 227 mg/dL) and decreases of 19-25% in patients with familial hypercholesterolemia (mean baseline LDL cholesterol 270 mg/dL). Interim results of a titrate-to-goal, 20-week study in patients with moderate hypercholesterolemia (LDL cholesterol greater than or equal to 160 mg/dL and triglycerides less than or equal to 350 mg/dL) demonstrate that fluvastatin, 20 mg/day, lowers LDL cholesterol by 21% within 6 weeks. Long-term results indicate that the lipid-lowering effects of fluvastatin are sustained for 96 weeks. Further, 1 study has shown that the combination of low-dose fluvastatin plus niacin decreased LDL cholesterol levels 40% without untoward adverse events, suggesting that this combination is effective and safe for patients needing intensive lipid-lowering therapy. Asymptomatic, reversible increases in hepatic transaminase levels occur in fluvastatin-treated patients at a frequency comparable to that reported for other HMG-CoA reductase inhibitors. The 20-30% reduction in LDL cholesterol required by the majority of patients with hypercholesterolemia can be achieved with fluvastatin at 20 or 40 mg/day as well as with the other available HMG-CoA reductase inhibitors at their most commonly prescribed doses. Fluvastatin, priced 40% lower than other statins, provides the most cost-effective means of safely achieving goal LDL cholesterol levels in these patients.