What are the benefits of switching a patient from Rosuvastatin ( Crestor ) to Atorvastatin ( Lipitor )?

From the Guidelines

Switching a patient from Rosuvastatin to Atorvastatin is not necessarily beneficial in terms of morbidity, mortality, and quality of life, as the choice of particular statin is a matter of preference, according to the expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents 1. When considering a switch, several factors should be taken into account, including:

• Potential cost savings, as atorvastatin is available as a generic and typically less expensive than rosuvastatin
• Different metabolic pathways, which may be preferred for patients with significant drug interactions
• Tolerability, as some patients who experience side effects with rosuvastatin might tolerate atorvastatin better, or vice versa Key considerations for switching include:
• Appropriate dose conversion, as rosuvastatin is more potent on a milligram-per-milligram basis, with 5 mg rosuvastatin approximately equivalent to 10-20 mg atorvastatin
• Monitoring lipid levels within 4-12 weeks to ensure therapeutic efficacy is maintained
• Watching for potential side effects such as muscle pain, liver function abnormalities, or changes in blood glucose levels with either medication The decision to switch should be individualized based on patient-specific factors, including cost considerations, side effect profile, drug interactions, and overall treatment goals, with the goal of minimizing morbidity, mortality, and improving quality of life 1.

From the FDA Drug Label

The individual components of the primary end point are presented in Figure 3 rosuvastatin significantly reduced the risk of nonfatal myocardial infarction, nonfatal stroke, and arterial revascularization procedures. Table 11: Percent Change in LDL-C by Dose of Rosuvastatin, Atorvastatin, Simvastatin, and Pravastatin From Baseline to Week 6 (LS MEAN 1) in Adult Patients with Hyperlipidemia or Mixed Dyslipidemia (Sample Sizes Ranging from 156–167 Patients Per Group) Rosuvastatin-46 2-52 3-55 4--- Atorvastatin-37-43-48-51

The benefits of switching a patient from Rosuvastatin (Crestor) to Atorvastatin (Lipitor) are not clearly established, as the provided drug label does not directly compare the two medications in terms of benefits for switching.

• LDL-C reduction: Rosuvastatin appears to reduce LDL-C more than atorvastatin at certain doses, but this does not necessarily translate to a benefit of switching from one medication to the other.
• Clinical outcomes: The label does not provide direct evidence that switching from rosuvastatin to atorvastatin would result in improved clinical outcomes, such as reduced risk of major CV events. 2

From the Research

Benefits of Switching from Rosuvastatin to Atorvastatin

• There are no direct benefits of switching a patient from Rosuvastatin (Crestor) to Atorvastatin (Lipitor) as the available evidence suggests that switching from rosuvastatin to atorvastatin may lead to fewer patients attaining LDL-C goal and a greater risk for major adverse cardiovascular events (MACE) 3.
• A study found that switching from rosuvastatin to atorvastatin resulted in a 4.8% fewer patients reaching their LDL-C goal and a 5-year relative risk for MACE of 1.109, indicating a greater risk for cardiovascular events 3.
• Another study found that switching from rosuvastatin to another non-equipotent lipid-lowering treatment, including atorvastatin, was associated with a higher probability of acute myocardial infarction (AMI) 4.

Comparison of Rosuvastatin and Atorvastatin

• Rosuvastatin has been shown to be more efficacious than atorvastatin in reducing LDL-C levels, with a greater decrease in LDL-C observed with rosuvastatin compared to atorvastatin at 1:1 and 1:2 dose ratios 5.
• However, at a 1:4 dose ratio, there was no significant difference between rosuvastatin and atorvastatin in terms of LDL-C reduction 5.
• Rosuvastatin has also been shown to be superior to atorvastatin in terms of tolerability and safety, with a lower risk of adverse events observed with rosuvastatin 6.

Clinical Implications

• The available evidence suggests that switching from rosuvastatin to atorvastatin may not be beneficial and may even be harmful, with a greater risk of cardiovascular events observed with atorvastatin 3, 4.
• Therefore, clinicians should exercise caution when considering switching patients from rosuvastatin to atorvastatin, and should carefully weigh the potential benefits and risks of such a switch 3, 4.