Is Deprescription of Ezetimibe Safe in Familial Hypercholesterolemia Patients Taking Evolocumab?

We evaluated whether low-density lipoprotein cholesterol (LDL-C) levels in familial hypercholesterolemia patients on triple lipid-lowering therapy would remain below intensification threshold values after withdrawal of ezetimibe. We included 13 heterozygous familial hypercholesterolemia patients with vascular disease who were treated with statin thorn ezetimibe thorn evolocumab; ezetimibe was discontinued at the patients' request. After 3 months, LDL-C levels increased from 0.96 +/- 0.51 to 1.54 +/- 1.07 mmol/L. In 12 of 13 patients, the LDL-C level remained below 1.8 mmol/L. No adverse cardiovascular events were observed. Deprescribing ezetimibe reduced pill burden but increased LDL-C level, although usually not above the treatment intensification threshold for high-risk patients.