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ARBITER 6-HALTS: A Surprise Knockout

• ARBITER 6 Widely Misinterpreted
• ARBITER 6-HALTS trial
• ARBITER 6-HALTS trial
• niacin dose
• This Trial re- opens the 'possibility' for Niacin
• ARBITER 6 zetia vs niacin

ARBITER 6 Widely Misinterpreted

Eliot A Brinton, University of Utah, 16 Nov 2009 11:26 PM EST

Competing interests: Research grants, consultant and speaker for both Abbott and Merck.

ARBITER 6 gives needed encouragement for use of niacin in patients with low HDL, with and LDL-C already at or near goal with statin monotherapy.

Due to its flawed design, however, the study is NOT informative about ezetimibe!

First, it compares two drugs which generally are NOT considered as alternatives for each other in the same patient (niacin being mainly for low HDL and ezetimibe being exclusively for high LDL).

Second, it selected patients for low HDL and low LDL, precisely those for whom niacin is a top choice and ezetimibe is rarely considered.

Third, LDL-C lowering consistently reduces CIMT ONLY during the first year or so of treatment. With 6 years of aggressive statin treatment BEFORE study entry, ARBITER 6 subjects were NOT expected to respond to additional LDL lowering by ezetimibe (or statin uptitration for that matter).

Thus, ARBITER 6 confirms benefit of niacin added to statins, as shown in ARBITER 2&3, but it was NOT designed properly to inform us about ezetimibe! It is a FAILED comparison study and should NOT be considered in clinical decisions regarding ezetimibe therapy.

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ARBITER 6-HALTS trial

Ronald E. Habros MD, 17 Nov 2009 11:03 PM EST

Competing interests: None declared

Once again an underpowered study using serrogate endpointes. Your wasting our time. Lets wait until we get some real data - adequate size with endpoints of MI, CVA or death.

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ARBITER 6-HALTS trial

Rudy Robinson, 23 Nov 2009 9:34 PM EST

Competing interests: None declared

Has anyone done a trial comparing niacin with statins in the first place? Or is that dangerous for one's career?

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niacin dose

randy k minion, 8 Jan 2010 10:03 AM EST

Competing interests: None declared

can anyone get patients up to 2000 mg of Niacin a day as was used in the trial?

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This Trial re- opens the 'possibility' for Niacin

Pichakacheri sureshkumar, P.V.S hospital, Kozhikkode, India, 9 Jan 2010 5:58 AM EST

Competing interests: None declared

As shown in this trial, I had a strong gut feeling that, ezetimibe either in combination with statin, or alone is not a good lipid lowering drug of choice! That feeling is being underscored by this results. Even further detailed randomized controlled , prospective trials, I am sure, would show the same results, especially when compared with Niacin in the context of CV outcome benefits!

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ARBITER 6 zetia vs niacin

LW Martin, 26 Jan 2010 5:58 PM EST

Competing interests: None declared

This study looks at CIMT over a year's time in a small group of patients on zetia vs niacin, in addition to statin. The detected difference in CIMT may be statistically significant, but the difference is exceedingly small and it is not clear that it is clinically relevant.

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