Vytorin Down, Crestor Up

Apr 16, 2008
By Pharmaceutical Executive Editors

Seventy-five percent of physicians in a new survey say they expect to prescribe less Vytorin and Zetia, with Crestor, Lipitor and Zocor/simvastatin expected to get the bulk of the switched prescriptions. The numbers come from a 25-page report issued last week by Deutsche Bank, documenting the cholesterol market's recent rollercoaster ride.

Key findings include:

  • Vytorin's share is expected to decrease from 16 percent to 9 percent, with Zetia dropping 3.5 share points to 6 percent
  • Doctors expect to switch 38 percent of their patients from Vytorin and Zetia to another treatment in the future
  • Lipitor does not show significant gains in overall future treatment volume (up from 25.6 percent to 26.4 percent)

Early analyst reports forecasted that although Vytorin would take an initial hit in prescriptions due to the results of the ENHANCE study, many expected the dip would not be long term. That's no longer the case. According to Deutsche Bank, things took a turn for the worse at the American College of Cardiology meeting, where a panel of cardiologists slammed the drug and recommended that it be used only as a last-resort treatment—after statins have failed.

The ENHANCE study showed Vytorin (simvastatin plus ezetimibe) to be no more effective at reducing arterial plaque than simvastatin alone in a small group of patients with severe hereditary high cholesterol. However, the drug has no safety issues, and is still at the top of its class at doing what it was approved by FDA to do—reduce LDL.

"Unfortunately, there is a perception and a reality to this," said Deutsche Bank analyst Barbara Ryan. "The reality, in my opinion, is that the data shouldn't be that important. It is looking at arterial plaque, not LDL. This was a hypothesis that failed to show any benefit, but you can't throw decades of study about LDL under the bus because of this negative study." Longer term, Lipitor goes off patent in 2010, which should create the impetus for step therapies that start with generic versions of Zocor and Lipitor then move on to other therapies if those fail.

"What's different this time is that we see that Crestor is the beneficiary," Ryan said. "If you look at the scrips in the report, the decline of Vytorin and Zetia was followed with a rise in prescriptions for Zocor and Crestor, and to a lesser extent Lipitor."

Crestor is expected to gain a significant percentage of share points, increasing to 20 percent from 15 percent, while Lipitor is forecast to rising just one point to 28 percent.

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