Yes it is a small study, but this refutes the notion that it is all a “gimic” study;

“. . . .Major adverse cardiovascular events occurred at a significantly higher incidence in the ezetimibe group (9 of 165 patients [5%]) than in the niacin group (2 of 160 patients [1%]) (P=0.04 by the chi-square test) (Figure 3, and Table 3 in the Supplementary Appendix). The effects of niacin on the mean carotid intima–media thickness were consistent across the prespecified subgroups: those stratified according to sex, presence or absence of diabetes, quartile of baseline HDL cholesterol level, and median cutoff points for baseline carotid intima–media thickness and C-reactive protein level. . . .

Just the same, namaste. . .

Sincerly, I do not mean to be pendantic, but what do you make of the statistically-significant Elevated Major Cardiac Event Risk seen in the Arbiter 6 study for the patients taking statins along with Zetia, as compared to those taking statins along with Niaspan?

Seriously, please explain — as your-supposed “marketing gimic” — the notion that Zetia patients had a 5% risk of major cardiac event, over 14 months, v. a 1% risk of major cardiac events, for the Niaspan patients.

I am all ears (erh. . . eyes) here.

Namaste

You have all reinforced exactly what I said, perhaps unknowingly so.

This study had little relevance and everyone went three degrees of separation to making a statement about Vytorin. No one commented on the study exactly for what it was, a marketing gimmick.

Zetia did exactly what it was supposed to do. It was never meant to raise HDL or lower trigs. All it does is lower LDL by a bit. But patients on both arms before going into the study already had their cholesterols aggressively lowered. So NO SURPRISE, zetia didn’t do any new tricks it has never done before.

It’s like comparing a Hummer with a Mini on climbing a rocky hill. Duh! That doesn’t make the mini a bad choice, just a bad choice to climb a rocky hill.

oh, by the way, Niacin in any of its forms has never been shown to reduce mortality or hospitalizations. What’s the excitement all about?

At the moment it appears the market is betting that HHS Secretary Sebelius won’t acquiesce to Senator Grassley’s strong suggestion that Vytorin/Zetia be moved to Tier III, or dropped altogether, from the formularies of approved meds — just as Illinois, New York and California did in 2008 (dropping it from top tier status, to one notch down), in response to ENHANCE.

I think that is a foolish bet.

Co-Pays are going to rise for the Vytorin/Zetia combination, and insurance coverage is going to decrease (or evaporate, altogther) — so MRK’s only possible remaining option will be to cut price to keep share. It will take time, but you will see it.

That “price drop” strategy can’t work long term, for the level of expense MRK carries to sell and support the cholesterol franchises.

Let’s see what the next four to six weeks bring.

Namaste

How can a doctor responsibly ignore this data — even though it is from a small study?

Answer: doctors won’t ignore it. Equally ominiously, Sen. Grassley wrote on Friday to HHS Secretary Sebelius — to discuss reimbeursement levels (by Medicare Part D, among other government programs), for these drugs.

As goes reimbursement, so goes the prospect for these two drugs — Zetia and Vytorin.

[Not to be politically-incorrect, here but] I think the fat lady is clearing her throat.

Namaste

Zetia is used- quite a bit as the 1st add on to a statin. Good advertizing, and the ease of use make it an easy drug to add on. it lowers LDL too- patients come back and see the LDL lower and think “great this copay was worth it” However, I think it’s pretty clear that this is not the best add on to a statin- and should be reserved for later use. LDL isn’t everything- and other drugs like Niaspan provide LDL lowering + HDL raising and TG lowering that Zetia can’t provide. These other measures make the difference.

The study compaired 2 treatments in patients who were already on Zocor- they recieved either Zetia or Niaspan. so you can infer that Zocor+ Niaspan did better then Zocor + Zetia. Vytorin was not used in the study- but its components were.

It’s well accepted that statins are the best 1st line agent- what isn’t clear is what do do next when a statin isn’t enough- which is often being you only get a 30-40% reduction in events on a statin. A direct compairison of Niaspan to a statin has never been done. But Niaspan has been shown to provide benifit beyond on top of what the statin can do.

There is plenty of other data on Niaspan out there to back the results of this trial up. Niacin’s been around 50 years.

Thanks for the perspective from the new Merck! However, it is a bit delusional. The results from this study again indicate no additional value of ezetimibe when added to a statin, making Zetia worthless x3. In addition, because Vytorin simply combines ezetimibe with simvastatin, there is no reason to prescribe Vytorin. Statins still rule the roost and now niacin, alongside resins and fibrates, remain the additive choices for those patients who do not completely respond to a statin. No doubt Zetia and Vytorin will start dropping like flies off of formularies nationwide. Their market share will be lost. It is no wonder that the top execs at Schering-Plough got out while they could. Now merck is holding and empty bag. So sad!

A friend