High-cost drug helps slash cholesterol

Mar 21, 2017, 00:46
High-cost drug helps slash cholesterol

Patients treated with injectable drug Repatha were 27 per cent less likely to have a heart attack and 21 per cent less likely to have a stroke over two years than if they had been taking statins alone. Inhibiting the protein can cause the level of LDL, or "bad" cholesterol, to tumble dramatically to unheard-of levels - from 92 milligrams per deciliter to 30 milligrams.

The worldwide team, which includes researchers from Imperial College London, says the drug could provide added benefit to patients already taking statins by further reducing the levels of low-density lipoprotein (LDL) cholesterol in their blood.

The UK section of the trial was organised by Imperial College London professor Peter Sever, with funding from the drug company Amgen.

The study mainly revolves around the severe major adverse cardiovascular event (MACE), which refers to events like first heart attack, strokes or cardiovascular death.

But that was based on early studies that showed the drug could merely reduce cholesterol and stop furring of arteries.

The study was conducted on 27,564 patients and almost 80 percent of them had suffered from a heart attack.

The study involved 27,564 men and women.

Although about 5% of patients in the clinical trial had a heart attack or stroke, rates of those problems could be two to three times higher in the real world, where patients are often older and sicker than those in clinical trials, Ofman said.

It means that if all 325,000 eligible Britons were to be treated, 2,200 potentially fatal heart emergencies would be avoided every year.

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The treatments were approved only for specific groups - those with a genetic condition which means they have dangerously high cholesterol, and people with heart disease who can not cope with the side effects of statins.

Repatha and Praluent, which belong to a class called PCSK9 inhibitors, are especially expensive because they would be taken for such a long time.

Stubbornly high cholesterol is a key risk factor. Insurers largely use pharmacy benefits managers to set up the lists that determine how much a patient ends up paying. But some people can not take them without significant side effects such as muscle pain, and in most people they do not lower LDL cholesterol as significantly as the new drugs. The results have also been published in the New England Journal of Medicine. Many doctors wondered if such low levels would be risky, causing memory problems or dementia due to a lack of cholesterol, said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, who was not involved in the new research but has led clinical trials of PCSK9 inhibitors in the past.

"A promising new approach is blocking the action of PCSK9, a molecule which reduces the breakdown of LDL-cholesterol in the liver".

Sabatine said he would like to see Repatha tested in other high-risk patients, such as those with type 2 diabetes, which could substantially increase the market.

The standard treatment for cholesterol, other than diet and exercise, is a generic statin, which costs $250 a year.

Dr. Donald Lloyd-Jones, preventive medicine chief at Northwestern University and an American Heart Association spokesman, called the results modest and "not quite what we hoped or expected". For now, "we should still probably reserve these for the highest risk patients where statins are not doing a good enough job - at least at the price they are currently offered", said Lloyd-Jones.

British Heart Foundation medical director Nilesh Samani said the trial was a significant advance. However, there are some deus which are prescribed to the patients with high levels of cholesterol but the cost of some them are really high.

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