generic internist

Vitamin Beats Statin: Is Merck's Zetia in Trouble?

Ncalmd, I just confirmed tonight, the formulary for Coventry and Southern Health still list Vytorin as tier 2 and Lipitor tier 3.

This makes no medical or scientific sense. Based on Arbiter 6, we now have more reason to suspect these perverse patient financial incentives may put lives in jeopardy.

I am not sure what goes on behind the closed doors of contracts between the insurance company and major pharmaceutical companies. Perhaps we have ceded too much power to the insurance industry and their pharmacy benefits managers.

Unfortunately, the major focus of telephone calls and office visits is beginning to be diverted into these formulary issues in an increasing number of my patients.

Vitamin Beats Statin: Is Merck's Zetia in Trouble?

thnks for reply, ncalmd. On the other coast I see more initial rx with vytorin, which should be reconsidered. I was quite surprised Mrk was actually starting to generally promote Zetia for initial rx (just before Enhance trial fiasco), not just for the statin intolerant.

I was also concerned that the patients in Arbiter 6 with greatest LDL reduction on Zetia, had greater plaque progression, suggesting unintended impaired reverse cholesterol transport.

Needless to say, I stopped using Zetia myself, on Monday, having used statin/Niaspan/Zetia combo for myself for primary prevention for several years. It will be interesting to see if I can show plaque regression in my triple therapy patients, after stopping Zetia

Vitamin Beats Statin: Is Merck's Zetia in Trouble?

"vitamin beats statin"? Started wrong footed, Zetia is not a statin, but then again Zetia is looking more wrong footed after sequential failure to show benefit in Arbiter6, Seas and Enhance trials.

Significantly the trend is toward harmful events in the Zetia arm of the Arbiter study. The study is small, but cannot be ignored as a possible early signal of harm. Zetia and Vytorin can no longer be used in a casual fashion as initial therapy.

Pharmaceutical Dollar Rationing by Results

So, if I go out to dinner and the experience is less than satisfactory, I should get a rebate or not be charged?

....and that risk should be shared by different providers??

.....and if I can't decide whether it was satisfactory, I could come back for my money one month or years later???

Schering Plough, Merck: Potential Cancer Concerns

Too much information, released prematurely and mishandled by the media and many experts. Reminds me of the Avandia story, still awaiting data.

I guess we could conclude that Vytorin reduces the most common lung cancer death, prevents breast cancer death, yet increases cancer in general (stomach, skin and prostate) so that you are more likely dead within 3 years of taking a cholesterol lowering drug.

I don't think we have ever encountered a drug in the history of medicine that can kill a patient with cancers in multiple systems within three years. Why should Zetia do this? We don't even have a proposed mechanism, even though we are doing more cancer than cardiovascular clinical trials. I don't expect the NIH though, to start running trials for cancer prevention using drugs that increase cholesterol absorption.

The Seas trial was randomized for cardiovascular risk factors.....I doubt that it was randomized for cancer risk factors such as familial cancer tendency or prior personal history of cancer (other than identifiable active cancer which would exclude one from most clinical trials).

It seems irresponsible for the NEJM to advocate the science, but then selectively discard it, if associated with the pharmaceutical industry Many of our patients will only hear the false cry of cancer, and discontinue therapy inappropiately.

Pfizer: Silly Counterfeiting Statistics, Bloomberg Edition

a disturbing position to take, Felix. In a medical system that has no tolerance for adverse outcome, you propose we overestimate the risk for drug counterfeiting. You may be correct, but the imported heparin substrate killed 88 individuals, that we know of. This should be a wake up call. We need to maintain our highest standards, which the rest of the world can try to emulate.

Rose colored glasses will not serve us well, if we open the door to a potential new form of bioterrorism.

Merck and Schering-Plough Make the Bad News About Vytorin Even Worse

19% of the ENHANCE group who were statin naive showed no benefit either, nor did a subgroup with greater plaque burden, at study entry. This bodes poorly for the Improve -it outcome study and the fate of zetia.