Cardiovascular Business - January/February 2008 - (Page 33)

› top 3 statin sellers in the u.s. • lipitor (Pfizer) – more effective than generic statins, most outcomes data. • vytorin (Merck/schering-Plough) – more effective than generic statins, possibly better than lipitor for lowering lDl but has little outcomes data, contains nonstatin Zetia which is contraindicated with certain drugs. • Crestor (astraZeneca) – more effective than generic statins, possibly better than lipitor for lowering lDl but has least amount of outcomes data among these top three. restricted in most hospital formularies, he says. The three top-selling statins on market in the U.S. are typically considered the most effective—Lipitor (Pfizer), Vytorin (Merck/Schering-Plough), and Crestor (AstraZeneca). Koren says that these are significantly more effective than any of the generic statins. “The LDL-lowering of the branded statins is currently superior, and the triglyceride-lowering of the branded statins is also superior, particularly Lipitor,” Koren says. Physicians need to explain these differences to their patients and patients need to decide if they are willing to pay for the additional efficacy. Lipitor, which has been on the market the longest, has the greatest outcome research and nearly every study attests to the drug’s safety and efficacy in reducing heart attacks, strokes, and other cardiovascular complications, Koren says. Vytorin and LDL- and triglyceride-lowering of the branded statins is currently superior to the generic statins. Crestor do not yet have this type of outcomes background. While Vytorin, a combination of simvastatin and Zetia, has had some positive outcomes regarding simvastatin, the gap of efficacy in the Zetia, or non-statin, component is still unclear, Koren says. “Vytorin probably does a little better than Lipitor in lowering LDL, but there is still a lingering doubt about using a non-statin mechanism for lowering LDL,” he says. In addition, simvastatin has more drug interactions than Lipitor. For example, it is contraindicated with the use of Amiodarone, an antiarrhythmic agent. Merck/Schering-Plough recently reported the results of the ENHANCE trial, which found that Vytorin was no more effective in treating patients who were genetically predisposed to having dangerously high levels of cholesterol than Merck’s drug Zocor because it did not slow the growth of artery blockages. Crestor is somewhat more effective at lowering LDL levels than Lipitor, but it has the least amount of outcomes data, Koren says. He adds that some of the clinical research that has been published about Crestor has not been uniformly positive. He specifically referenced the CORONA trial that was released at last year’s AHA Scientific Sessions in Orlando, Fla., in which Crestor did not meet its endpoint of showing benefit with congestive heart failure patients, though some confounding factors may have interfered with its results, such as the European patients in the study were dying from factors other than heart attacks. Merck & Company recently failed its third attempt to gain FDA approval to sell its generic simvastatin over-the-counter (OTC), which would create a much larger market for the company. Koren says that the FDA has historically resisted the efforts to sell drugs over-the-counter that require consultations with a professional. He says that a change of the type of self-prescription would require a change in U.S. healthcare model, in which the patient would have a much more proactive role for treatment that requires chronic therapy. “The ongoing battle is between having greater outcomes data and more efficacy compared to what people want to pay,” Koren concludes. CardiovascularBusiness.com Cardiovascular Business http://CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2008

Cardiovascular Business - January/February 2008 Contents The Ticker: Quality Pays in Several Ways Cover Story: The Proof: Why Evidence-based Medicine Improves Cardiac Care Clinical Study Digest: Co-payments and Cath Labs Cardiac PET/CT Fills in Gaps Left by SPECT Tapping into IT to Improve the Office-Based Practice SPECT–Proving Its Value Cardiac Images in the EMR: Just a Click Away The Top 20 Ways to Market Your Cardiac CTA Practice The Big Picture: Medical Displays for Cardiac Images Statins Work But Pharmacoeconomic Caveats Abound Driving Data Protection: Opting for Storage On- or Offsite News & Views Calendar Reader’s Resource

Cardiovascular Business - January/February 2008

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