Thursday, August 21, 2008

Vytorin: No good reason to use, yet 80,000 prescriptions a week

The Medical Letter is an non-profit, non-industry funded publication that reviews therapeutics. They are one of the few unbiased sources about drugs, sort of like a Consumer Reports for pharmaceuticals. The Medical Letter is a paid subscription service, so you may not have access to their recent article on Ezitimibe Revisited. Ezitimibe or Zetia is the second compononent of Vytorin, which combines Zetia with a statin (simvastatin). The Medical Letter describes both the ENHANCE trial and the SEAS study, both studies which showed no benefit of Vytorin. I have blogged about Vytorin and these studies in previous posts (including Zetia In, Vytorin Out and Dear Doctor: Vytorin ), and the good folks at The Medical Letter have drawn the same conclusions I have.

"A large clinical-endpoint trial in patients with hypercholesterolemia comparing the simvastatin-ezetimibe combination with simvastatin alone is underway; results are expected in 2012. Until then, drug treatment of hypercholesterolemia should continue to aim at achieving LDL-C levels below 100 mg/dL in high-risk patients and, if possible, below 70 mg/dL for patients at very high risk. For patients who cannot achieve these goals with a safe dose of a statin alone, adding another LDL-C lowering drug such as niacin, a bile acid sequestrant or ezetimibe continues to be a reasonable option."

In other words, for patients requiring cholesterol lowering drugs, first start with a statin. If goals can not be achieved, several options including adding Zetia seem reasonable. Since other statins such as Lipitor or Crestor are more potents then simvastatin and other generics, if cholesterol goals can't be acheived with a generic, a switch to a more potent statin should be considered (or Lipitor or Crestor should be started in patients whose LDL is too high for simvastatin to acheive control). If cholesterol goals are still not acheived, then one can add Zetia. Thus, there is really no reason to ever use Vytorin. Interestingly, as of last month, according to the Wall Street Journal, "new prescriptions for Vytorin in the US have held steady at more than 80,000 a week over the last month."

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