Efficacy and safety of rosuvastatin therapy in children and adolescents with familial hypercholesterolemia

CHARONEfficacy and safety of rosuvastatin therapy in children and adolescents with familial hypercholesterolemia

Marjet J. A. M. Braamskamp, MD*, Gisle Langslet, MD*, Brian W. McCrindle, MD, MPH, David Cassiman, MD, PhD, Gordon A. Francis, MD, FRCPC, Claude Gagne, MD, FLNA, FAHA, Daniel Gaudet, MD, PhD, Katherine M. Morrison, MD, FRCPC, Albert Wiegman, MD, PhD, Traci Turner, MD, D. Meeike Kusters, MD, Elinor Miller, AB, MD, Joel S. Raichlen, MD, Jenny Wissmar, MSc, Paul D. Martin, PhD, Evan A. Stein, MD, PhD, John J. P. Kastelein, MD, PhD

OBJECTIVE: Heterozygous familial hypercholesterolemia (HeFH) is an autosomal dominant disorder leading to premature atherosclerosis. Guidelines recommend initiating statins early to reduce lowdensity lipoprotein cholesterol (LDL-C). Studies have evaluated rosuvastatin in children aged $10 years, but its efficacy and safety in younger children is unknown. METHODS: Children with HeFH and fasting LDL-C .4.92 mmol/L (190 mg/dL) or .4.10 mmol/L (.158 mg/dL) with other cardiovascular risk factors received rosuvastatin 5 mg daily. Based on LDL-C targets (,2.85 mmol/L [,110 mg/dL]), rosuvastatin could be uptitrated to 10 mg (aged 6– 9 years) or 20 mg (aged 10–17 years). Treatment lasted 2 years. Changes in lipid values, growth, sexual maturation, and adverse events (AEs) were assessed. RESULTS: The intention-to-treat analysis included 197 patients. At 24months, LDL-C was reduced by 43, 45, and 35% vs baseline in patients aged 6–9, 10–13, and 14–17 years, respectively (P ,.001 for all groups). Most AEs were mild. Intermittent myalgia was reported in 11 (6%) patients and did not lead to discontinuation of rosuvastatin treatment. Serious AEs were reported by 9 (5%) patients, all considered unrelated to treatment by the investigators. No clinically important changes in hepatic biochemistry were reported. Rosuvastatin treatment did not appear to adversely affect height, weight, or sexual maturation. CONCLUSIONS: In HeFH patients aged 6–17 years, rosuvastatin 5–20 mg over 2 years significantly reduced LDL-C compared with baseline. Treatment was well tolerated, with no adverse effects on growth or sexual maturation.

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