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Vytorin Prescriptions Down Again After Brief Reprieve

Feb 20, 2008 | Parker Waichman LLP Vytorin prescriptions have fallen again, dashing hopes at Merck and Schering-Plough that the fallout from a disappointing Vytorin study was starting to ebb.  Vytorin prescriptions had fallen immediately after the release of the ENHANCE study on January 14, but had appeared to rebound the past few weeks.  Today’s news that Vytorin prescriptions are down again indicate that the drug makers’ have a long way to go to repair the damage wrought by ENHANCE

Vytorin is a combination of cholesterol lowering Zetia and the statin Zocor. The point of the ENHANCE study was to determine how well Vytorin prevented clogged arteries by reducing the formation of plaque. ENHANCE focused on a group of 720 patients with a rare condition predisposing them to high cholesterol. The patients were given either Vytorin or a high dose of simvastatin, the generic form of Zocor. Vytorin did not provide any significant benefit versus the statin drug Zocor in slowing down clogging of the arteries. Overall, the study failed to meet its primary goal, which was to show whether Vytorin was more effective than Zocor alone in preventing progression of atherosclerosis in the carotid artery, which is in the neck.

Such plaque buildup is a major risk factor for heart attacks and stroke. Many doctors had been prescribing Vytorin on the theory that the drug would reduce this risk in people with high cholesterol. The ENHANCE study is a serious blow to this theory.

Those revelations caused many in the medical community to question the wisdom of prescribing Vytorin, which costs about $3/pill, rather than high dose of a less expensive statin at about $1/pill. Among the new Vytorin critics was Dr. Steven Nissen, chairman of cardiology at the Cleveland Clinic. Dr. Nissen told CBS News that he would advise doctors to quit prescribing Vytorin, since it was not shown to be more effective than Zocor. “My advice to physicians is not to use this drug Vytorin nor to use Zetia as first line agents any more. These should be really relegated to drugs of last resort until we have some evidence that they produce a health outcomes benefit,” he said. “Right now, five years into this, with nearly 1 million prescriptions per week being written, there is no evidence that the drugs actually produce any benefit for patients.”

Immediately following the release of ENHANCE, Vytorin prescriptions fell by about 9.5%.  According to the Wall Street Journal, they then started to recover as the Merck and Schering-Plough stepped up efforts to persuade doctors to resume prescribing them as they had before. In an earnings call last week, Schering-Plough CEO Fred Hassan voiced his support for Vytorin, saying, “The doctors generally knew that this was one of those media-driven situations.”

But Hassan may have spoken too soon.  According to the Wall Street Journal, Vytorin prescriptions for the week ended February 15 were off 7% to 327,698 compared with the previous week. And the prescriptions were down nearly 18% from the week preceding the release of the study results on January 14.

The precipitous fall of Vytorin prescription likely has more to do with the fact that the drug offers no additional benefits compared to cheaper statins than it does with media hype.  It’s understandable that patients would not want to pay a premium for Vytorin when less expensive alternatives are available.  Unfortunately, for Merck and Schering-Plough, that reality is not “media-driven.”

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