Vytorin Panic

News that the popular cholesterol drug Vytorin may not work to protect arteries and may in fact worsen clogging should not cause patients to panic, the American College of Cardiology said on Tuesday.

"There is no reason for patients to panic," the ACC said in a statement.

"This is not an urgent situation and patients should never stop taking any prescribed medications without first discussing the issue with their health care professional," the statement added.

Vytorin combines two cholesterol-lowering drugs --- ezetimibe, sold under the brand name Zetia, and simvastatin, sold generically and under the Zocor brand name.

The study involved 720 patients with very high levels of cholesterol from an inherited form of heart disease. Doctors made images of their arteries to see if the drugs slowed the buildup of plaque, but the results showed that Zocor alone in fact worked better than Vytorin.

[Reuters, 15 Jan 2008]

In the last medical convention I attended, a respected cardiologist spoke on behalf of Vytorin, and as customary in sessions like that, heaped praises on the said medication. Colorful Powerpoint slides peppered his talk with mentions of this and that study supporting the claim of how effective Vytorin is on lowering bad cholesterol. He even suggested that it can be made a part of the first-line therapy for patients with very high lipid profiles.

Now comes this study that Vytorin does not really lower fatty deposits in arteries.

What can be worse than that? Well, the study showed that the fatty deposits in those patients taking Vytorin grew twice as fast!

Ok, that's bad. But is there something still far worse than that? Well, yes. There are allegations that after gaining more than $5 billion in sales last year, the drug manufacturers of the said drug "had been cynically sitting on the results for more than a year."

As for the extended delay in reporting the results of the Vytorin study, called ENHANCE, Schering-Plough spokesperson Lee Davies told TIME that it was due to the time involved in reading and interpreting the tens of thousands of images of the carotid arteries that the study generated.... [TIME, 15 Jan 2008]

That long, huh? Too many images might have strained their eyes.

Doctors should be careful with those drug manufacturers which engage in heavy promotions. Like any other businessmen, these people seem to have little regard for the safety and well-being of sick patients. For them, it's all about meeting targets and quotas and of course, profits and ROIs.

In the Philippines, one 10/10mg tablet of Vytorin sells for P111.25 each at a leading pharmacy. Even with a senior citizen discount, the total amount for this medication's total daily dosage can amount a few hundred pesos.

If consumers learn that their expensive medication is not doing them any good, should they panic? You tell me. Personally, I think they should go and consult their doctor immediately for a possible alternative. Though I doubt if that will happen. You see, these seniors are very frugal. They know one trip to their doctors can be costly. What happens now?

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FINAL ANALYSIS....

Vytorin, by combining Zocor and Zetia, produces a bigger drop in cholesterol than either drug could do alone, and without a marked increase in side effects. The problem is that there are no long-term studies showing that using the drug translates into fewer heart attacks or strokes.

The latest study was a step in that direction. It didn’t set out to measure heart attacks or strokes, but it did look at whether Vytorin slowed plaque buildup on artery walls more than a statin alone.

It didn’t. While it’s been reported that the Vytorin users had more plaque than the Zocor users, that’s not a scientifically correct reading of the data: the difference between the two groups was not statistically significant.

Most important, perhaps, nothing about the trial undermines the settled wisdom about cholesterol and heart disease. The science still shows that lower cholesterol is better, however you achieve it. [NYTimes, 22 Jan 2008]