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Ezetimibe (Zetia): Why Are Nosotros Nevertheless Prescribing What Appears To Last A Useless Drug? Update*: Novel Report Comes Out Which Is Nevertheless Non Real Convincing.

Influenza A virus subtype H5N1 wellness inquiry fellowship only released a list of the 100 top drugs inwards America according to sales. 29th on the list, amongst sales of over 1.8 billion, is the cholesterol lowering drug ezetimibe, build cite Zetia. This drug was released over 10 years agone because it worked genuinely good inwards combination amongst statin drugs such every bit Zocor (simvastatin) to lower LDL cholesterol levels. It was released every bit a unmarried agent in addition to combined amongst simvastatin every bit Vytorin. The only work was that inwards 2008 a study of the ezetimibe/simvastatin combination compared to simvastatin lone showed the combination did non improve measurements of arterial wall thickness which correlates amongst things similar pump attacks in addition to strokes. Although cholesterol levels were lower inwards the combination arm, simvastatin was only every bit effective inwards achieving the to a greater extent than meaningful outcome. Ezetimibe appeared to increment cancer risk inwards approximately other study, evaluating patients amongst aortic stenosis. Influenza A virus subtype H5N1 study which compared adding niacin or ezetimibe to statin therapy inwards patients amongst coronary pump illness inwards 2009 showed that, fifty-fifty though ezetimibe was real effective inwards reducing LDL cholesterol levels, it also increased the thickness of the arterial walls when compared to niacin. Niacin wasn't nearly every bit expert at reducing cholesterol levels every bit ezetimibe, but at that topographic point were to a greater extent than cardiovascular deaths inwards the ezetimibe group.

This drug, whose only claim to fame is that it reduces a number on a chemical scientific discipline panel, continues to live pop inwards both the the United States in addition to Canada. An editorial inwards the Journal of the American Medical Association (JAMA) inwards 2014 wondered at the failure of real convincing evidence to build us halt prescribing it. The writer concluded that it must live that the manufacturer (Merck) has been real effective at marketing ezetimibe in addition to that patients' in addition to doctors' fixation on reducing the cholesterol numbers has made it attractive inwards defiance of its lack of efficacy. Statin drugs, which also are non immune to controversy, may trim down the risk of pump attacks past times reducing inflammation, non past times reducing cholesterol levels per se. Since ezetimibe acts to trim down absorption of cholesterol from the gut, it may own got no number at all on inflammation or vascular wellness despite lowering cholesterol levels.

There are farther studies notwithstanding inwards the pipeline which may clarify the province of affairs a chip more. It seems correct now, though, that at that topographic point is plenty evidence that this is a bad drug for the Food in addition to Drug Administration to rescind its approval. It would live overnice to believe that physicians would accept the first to modify their prescribing habits, removing 1.8 billion dollars from our healthcare mouth patch reducing our patients' pill burden, but plainly nosotros are non stepping upward to the plate.

*Note: The Medical Letter came out Dec 8, 2014, reporting that a novel study, reported at the American Heart Association Scientific Sessions showed that adding ezetimibe to forty mg of simvastatin did improve outcomes. The study, called IMPROVE-IT looked at a composite of cardiovascular events, including cardiovascular death, stroke or coronary revascularization in addition to flora that subsequently seven years 2742 events had occurred inwards the 9077 patients receiving simvastatin forty mg daily alone, in addition to only 2572 events had occurred inwards the 9067 patients receiving a combination of simvastatin forty mg amongst 10 mg ezetimibe. This is a pretty tiny proportion of patients, in addition to a real long study. Using Costco drugstore prices, the combination of ezetimibe in addition to simvastatin (still on patent) costs $644 for ninety days, every bit compared to generic simvastatin which costs a chip over $13 for 100 pills. This calculates out to nigh a million dollars per cardiovascular trial avoided. As an private patient, you lot would own got to accept this drug for seven years at a cost of over $18,000 for a 1.7% risk of avoiding a stroke, pump assail or cardiac physical care for such every bit a stent or a bypass operation. I haven't seen the actual study, since it doesn't appear to own got been published, but at that topographic point may live to a greater extent than interesting information there, such every bit what per centum of patients genuinely took the drug for seven years in addition to whether at that topographic point was whatever actual divergence inwards decease or disability. I also await frontward to information on side effects which should live available when the study is published in addition to may live interesting, subsequently such a large in addition to long term trial.

Addendum: The IMPROVE-IT study lastly came out inwards the New England Journal of Medicine. There was a 40% +dropout rate. Deaths from all causes in addition to cardiovascular causes were the same for the ezetimibe/simvastatin vs the simvastatin lone groups. Also, this study compares simvastatin to the combination of simvastatin in addition to ezetimibe, but atorvastatin, which is significantly to a greater extent than strong than simvastatin (also has less drug interactions) is generic in addition to inexpensive. Atorvastatin, which is nigh $32 for a ninety 24-hour interval supply, compared to nearly $700 for the ezetimibe/simvastatin combination, would real probable outcome inwards improve outcomes than simvastatin. Since both atorvastatin in addition to simvastatin are off patent, at that topographic point volition in all likelihood non live a definitive study comparison the two.

Another addendum: correct right away (12/14) the FDA is debating the significance of IMPROVE-IT in addition to other information regarding the value of ezetimibe. Apparently at that topographic point was a asking past times Merck to claim that adding ezetimibe to statin therapy reduces the risk of cardiovascular disease. It looks similar FDA is going to deny that claim, based on the extremely modest number inwards a real tiny subpopulation. The give-and-take is here. (that link may live temporary)


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