ACC panel unleashes Vytorin whirlwind

If Merck and Schering-Plough really expected their Enhance presentation to turn the tide on Vytorin and Zetia, then they were sorely disappointed this weekend. At the American College of Cardiology confab, a panel of heart docs said the Enhance data offered little redemption for Zetia and its cousin Vytorin, a Zetia-and-Zocor combo med. The media coverage today is extensive. Here's a representative sampling:

  • Enhance data showed no benefit to treatment with Vytorin, the study's lead investigator said. "Zilch." John Kastelein told the WSJ Health Blog that Enhance was a "trial out of hell" and that he'll never conduct research in the same way again.
  • Before a panel of experts spoke to the ACC, they reached consensus on the two meds and issued a press release urging docs to back away from the drugs. The cardiologists recommended a return to tried-and-true cholesterol treatments such as Merck's Zocor--which recently went generic--Pfizer's Lipitor, and AstraZeneca's Crestor. These meds have been shown to not only lower bad cholesterol, but also have effects on heart disease, the docs said.
  • Wall Street analysts, stunned by the negativity of the ACC discussion on Vytorin and Zetia, lowered their sales estimates for the meds and downgraded Schering-Plough's stock.
  • The New England Journal of Medicine said Vytorin and Zetia may not work and should only be used as last-resort alternatives if other cholesterol treatments--diet, exercise, statins, niacin, fibrates, and resins included--either fail to work or can't be tolerated by a patient. There's no evidence that the drugs help patients, a Yale cardiologist told the ACC meeting, and may even be harmful.
  • Researchers found that the U.S. spent billions more on Vytorin and Zetia than Canada did, positing that the lack of DTC advertising in Canada may account for the difference.
  • Schering-Plough stock dropped 17 percent before the bell this morning and Merck fell 10 percent.
  • Amid the firestorm of bad publicity, Merck and Schering-Plough stood behind their products, citing various reasons why Enhance failed to prove Vytorin's superiority; for one thing, patients in the study had been treated already with statins, and so it would be more difficult to show a benefit. The companies said the meds remain good first-line treatment options for cholesterol.

No doubt the data will continue to get sifted and hashed over in coming days. But until outcomes data for Vytorin are available--now unlikely until at least 2012--any new, concrete info will be hard to come by.

- here's the release from Merck
- read the Associated Press story on the retreat to older meds
- see Kastelein's comments in the Health Blog
- check out what analysts are telling the WSJ
- find the NYT's coverage of the meeting
- read New Scientist's story about Canadian ezetimibe spending
- see the stock performance news at MarketWatch

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