Zetia "could be expensive placebo," ACC hears

At the annual meeting of the American College of Cardiology, held in Chicago, a panel of leading cardiologists addressed the problems highlighted by the controversial ENHANCE study. US drug majors Schering-Plough and Merck & Co are facing allegations they withheld unfavorable data from the trial which assessed their co-marketed cholesterol drugs Vytorin (ezetimibe and high-dose simvastatin) and Zetia (ezetimibe).

The chairman of the ACC panel, Harlan Krumholz, noted that medical practice should change and that absolute reduction in low-density lipoprotein cholesterol may not be as important as how it is lowered. Findings from the long-awaited ENHANCE study could have boosted sales of both Vytorin and Zetia but were delayed by two year and, when finally announced, they showed that Vytorin was no more effective than Merck's off-patent statin Zocor (simvastatin) at slowing the clogging up of arteries (Marketletter January 15, 2008).

According to Lehman Brothers analyst Tony Butler, the panel stated that Zetia may just be an "expensive placebo" and recommended that physicians prescribe fibrates, niacin or resins if aggressive statin therapy does not achieve LDL treatment goals. The news could boost sales of Anglo-Swedish drug major AstraZeneca's Crestor (rosuvastatin calcium) and Solvay/Abbott's TriCor (fenofibrate).