Cholesterol drugs clash head on

By Dr. Ananya Mandal, MDNov 16 2011

Major cholesterol lowering drugs are being pitched against each other. The cheaper ones are more likely to win say experts.

In a head-to-head test of two of the leading statins high doses of blockbuster drugs Lipitor (Atorvastatin) and Crestor (Rosuvastatin) did about equally well, according to a study of 1,385 patients presented at the annual meeting of the American Heart Association in Orlando.

The latest study lasted two years in which about two-thirds of patients had less plaque in their arteries. The study was published in The New England Journal of Medicine. Both statins shrunk the size of plaque in the coronary artery by about 1%. That's an “unprecedented” level of plaque shrinkage, says study co-author Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic.

But Nehal Mehta, a cardiologist with the University of Pennsylvania's School of Medicine, said there's no way to know if such a small change actually matters, in terms of preventing heart attacks and saving lives. And relatively few patients would even benefit that much. Only about 20% of patients are taking such high doses — 40 milligrams daily of Crestor or 80 milligrams daily of Lipitor, says Mehta, who wasn't involved in the study.

Those on Crestor had a “bad cholesterol” (low-density lipoprotein or LDL) level of 63 milligrams per deciliter, while those who took Lipitor had a level of 70. Those who took Crestor had a “good cholesterol” (high-density lipoprotein or HDL) level of 50 milligrams per deciliter, compared to 49 for those who took Lipitor. Nissen notes both the drugs caused few serious side-effects. Previous studies showed high dose of rosuvastatin raises HDL, or good, cholesterol but that atorvastatin had no effect on good cholesterol. Participants also had fewer heart attacks, strokes or angioplasty procedures than the rates typically seen in people on lower doses of statins.

However Lipitor, made by Pfizer, will soon be much cheaper than Crestor and this could work in its favor said Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill, who was not involved in the study.

At present cholesterol lowering drugs are the leading class of prescription drugs in the USA, with 255 million prescriptions a year. Lipitor, the country's best-selling drug, with sales of $7.2 billion last year, will be available as a generic Dec. 1, at a fraction of its current cost. Patterson added that there will be no reason for insurance plans to pay for Crestor. Crestor is the eighth-leading drug in the USA, with $3.8 billion in annual sales. In fact, by next month, nearly all statins will be available generically. Generics now account for 78% of all retail prescriptions sold, according to IMS Health. Crestor, made by AstraZeneca, “will be the last major statin not on patent,” Patterson said. “The market for Crestor will go close to zero,” he predicted.

Such minor differences in cholesterol levels are unlikely to affect heart disease risk, Patterson explained from the study. “The bottom line is that there isn't a difference” between drugs, he said. “You should make your decision on other factors, like which one is least expensive.”