Which is better to start, Lovaza (Omega-3-acid ethyl esters) or fenofibrate, for treatment?

From the Guidelines

Fenofibrate is generally the better choice for patients with high triglycerides combined with low HDL cholesterol, as it can address both issues simultaneously, although Lovaza may be more suitable for patients with very high triglycerides (>500 mg/dL) or those with kidney disease. When deciding between Lovaza and fenofibrate, it's essential to consider the patient's specific lipid abnormalities and medical history. Fenofibrate is typically started at 48-145mg daily, depending on the formulation, and can reduce triglycerides and increase HDL cholesterol, as seen in the FIELD study 1. Lovaza, on the other hand, is more specifically targeted at very high triglycerides and has fewer drug interactions.

Some key points to consider when making this decision include:

• The patient's complete lipid panel, including triglyceride and HDL cholesterol levels
• Medical history, including the presence of kidney disease or other conditions that may affect the choice of medication
• Other medications the patient is taking, as fenofibrate can interact with certain drugs
• The potential side effects of each medication, including digestive issues, muscle pain, and liver problems with fenofibrate
• The importance of lifestyle modifications, such as diet and exercise, in managing lipid abnormalities, as noted in the 2013 ACC/AHA guideline 1.

It's crucial to discuss the individual patient's situation with their healthcare provider to determine the most appropriate treatment option. The FIELD study 1 and the 2013 ACC/AHA guideline 1 provide valuable insights into the effectiveness and safety of fenofibrate and Lovaza, but the decision should be based on the patient's unique needs and circumstances.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Comparison of Lovaza and Fenofibrate

• Lovaza, an omega-3 fatty acid, and fenofibrate are both used to treat patients with hypertriglyceridemia 2, 3, 4, 5.
• A study comparing the effects of omega-3 fatty acids and fenofibrate found that fenofibrate had better effects on lipoprotein and metabolic profiles in patients with hypertriglyceridemia 2.
• Another study found that the combination of omega-3 fatty acids and fenofibrate had significantly better effects on triglycerides and triglycerides/HDL cholesterol ratio compared to fenofibrate alone 3.
• Omega-3 fatty acids, such as Lovaza, have been shown to be well-tolerated and effective in lowering plasma triglyceride levels, with minimal side effects 4, 6.
• Fenofibrate, on the other hand, has been shown to have favorable effects on lipoprotein particle size and subclass distribution, and to decrease non-HDL cholesterol and increase HDL cholesterol 2, 3.

Efficacy and Safety

• The efficacy of Lovaza and fenofibrate in reducing triglyceride levels has been established in several studies 2, 3, 4, 5.
• The safety profiles of Lovaza and fenofibrate are generally favorable, with few side effects reported 4, 5.
• However, the choice between Lovaza and fenofibrate should be based on individual patient needs and medical history, as well as the specific goals of treatment 5.

Combination Therapy

• The use of combination therapy with omega-3 fatty acids and fenofibrate may be beneficial in patients with hypertriglyceridemia, as it has been shown to have additive effects on triglyceride reduction and improvement in metabolic profiles 3.
• However, further studies are needed to fully evaluate the effects of combination therapy on cardiovascular outcomes and CVD risk reduction in patients with hypertriglyceridemia 5.