Alternate-day vs. daily dosing of rosuvastatin: a meta-analysis of its efficacy in lowering lipid profile levels

To evaluate the comparative efficacy of alternate-day versus daily moderate-intensity (10 mg) rosuvastatin in managing lipid profiles.

A systematic literature review was conducted across PubMed, Scopus, Google Scholar, and EBSCOhost as of March 27, 2026. Six studies (four RCTs and two non-randomized) involving participants with dyslipidemia, hyperlipidemia, or T2DM-associated dyslipidemia were analyzed. All participants received moderate-intensity rosuvastatin. Pooled mean differences (MD) and standardized mean differences (SMD) were estimated using random-effects models.

Alternate-day dosing yielded significant within-group improvements from baseline in total cholesterol (TC) (MD = -52.32, 95% CI: -69.02 to -35.61, p < 0.00001), triglycerides (TAG) (MD = -45.49, 95% CI: -77.21 to -13.78, p = 0.005), and low-density lipoprotein (LDL) (MD = -48.97, 95% CI: -58.05 to -39.88, p < 0.00001). High-density lipoprotein (HDL) increased significantly (MD = 4.58, 95% CI: 2.29 to 6.87, p < 0.0001). In direct post-intervention comparisons, no statistically significant differences were detected between alternate-day and daily dosing for TC (SMD = 0.01, 95% CI: -0.39 to 0.42, p = 0.94), TAG (SMD = 0.03, 95% CI: -0.19 to 0.25, p = 0.78), HDL (SMD = -0.03, 95% CI: -0.25 to 0.19, p = 0.80), or LDL (SMD = -0.02, 95% CI: -0.41 to 0.37, p = 0.90).

Alternate-day dosing of moderate-intensity rosuvastatin was associated with significant within-group improvements in lipid parameters. However, the absence of statistically significant between-group differences should not be interpreted as evidence of equivalence or non-inferiority, particularly because the confidence intervals remain compatible with potentially clinically meaningful differences. Alternate-day dosing may be considered an exploratory strategy in selected patients, but stronger evidence from adequately powered non-inferiority trials is needed.