The State of Statins and Stents

Leerink Swann, which specializes in healthcare equities research, is out with a couple of noteworthy surveys--one on the collateral damage to Merck (MRK) and Schering-Plough's (SGP) Vytorin this week and the other on drug-coated stents from Abbott Labs (ABT), Boston Scientific (BSX), Johnson & Johnson (JNJ), and Medtronic (MDT).

Leerink has a medical expert unit called "MEDACorp" that it relies on for ears-to-the-ground, real-world research. In the wake of the study that broke last Monday showing a higher incidence of cancer among patients who took Vytorin, MEDACorp canvassed 100 general practitioners and cardiologists for their reactions to the news. The survey was started Tuesday afternoon, so the news had been out for about 24 hours by that time. 83% of the docs said they hadn't yet heard from patients or, if they did, the inquiries were few and far between.

And of the patients who did call their doctor with concerns, Leerink says "the average inquiry was not alarmist". Nonetheless, the doctors said they still expect that they're going to write fewer prescriptions for Vytorin and Zetia (Vytorin is made with Zetia and Zocor) over the next year. Leerink is forecasting a worst-case scenario decline of 20-30 percent. Earlier this week, MRK held back on providing financial guidance for this year and beyond until it can get a better handle on the impact the cancer scare might have on V-Z sales. The companies say the higher number of cancer cases is likely an anomaly.

Then, Friday morning the same firm was out with an amalgam of survey results showing that the use of drug-coated stents continues to bounce back and that prices aren't going down as much as some had thought they would now that there are four players in the U.S. market. Leerink says seven out of 10 stents that are being put in are coated with a drug and that interventional cardiologists--the docs who implant the tiny wire mesh tubes--expect that rate to tick up slightly higher over the next few months.

Many analysts had been predicting a price war this year as MDT and ABT busted up the duopoly owned by BSX and JNJ. But Leerink says its research shows that prices are not collapsing. Boston Scientific is selling the new ABT Xience stent under a different brand name, Promus. It's entitled to do that based on the terms of the Guidant acquisition/divestiture.

Anyway, Leerink says Promus is "the highest-priced stent on the market which might suggest recent commentary indicating that BSX will be aggressive with price may be overstated." Some have suggested that because the newest ABT-BSX drug-coated stent looks to be better, safer and easier to thread than the competition that the companies might be able to charge a premium.

Leerink Swann may trade in the stocks of all of the above-mentioned stentmakers and drugmakers.

Comments

[redbaron:]

'The companies say the higher number of cancer cases is likely an anomaly.'

I don't see how they can have it both ways, i.e., how can the drug co.'s use the data to legitimately support the use of statins, and at the same time selectively ignore the rest of the data as an 'anomaly'? And, I might add, ignore the data that shows no benefit in terms of additional longevity from the use of statins.

One could as easily use the same data to 'selectively' conclude, 1) there is no increased longevity from these drugs, and 2) there is a 50% additional risk from cancer deaths. Again, this is selectively using the data, but isn't that what the drug companies are doing?

How can an individual private practice doc make rational decisions for their patients, when the drug companies are self promoting the drugs in this fashion? The standard of care dictates one thing, and one could selectively interpret the data in quite the oposite fashion.

It would seem to me that we need good statistical independent interpretation of the data, with the key word being 'independent'. And additionally, it is quite apparent to me that the drug companies are not going to be the source of that interpretation. One would also have to wonder if our FDA is independent enough to perform this task.

As for me, I will not take the drugs again.

2008 Jul 27 11:54 AM

[CLH:]

If the drug company believes the cancer cases are an anomaly, the FDA should ask for a larger study. In fact the drug company should do it on their own to protect themselves.

No drug companies are not evil.

2008 Jul 27 01:58 PM

[jrhc:]

The higher number of cancer may be called 'anomaly' because ezitimibe doesn't show potential to damage DNA or other 'pro cancer' properties. The only way to close the issue is longer observational studies (like the Nurses' Health Study I and II studies) with more than 40,000 people.

2008 Jul 27 05:01 PM

[GRR:]

Redbaron - The cancer issues was assessed by an independent group, it was not done by "the company". They looked at the meta analysis of the data on patients taking Vytorin to date in several large studies. That's how they came up with the "anomaly" term for what happened in the SEAS trial. It was an anomaly, based on the other data available on thousands of patients who have taken this med. Also, they (or the FDA or anyone else) can not say that there is or is not increased longevity from Vytorin because that sudy is not completed yet.

2008 Jul 30 08:29 AM