Costly drug cuts cholesterol risk in heart patients
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A new cholesterol-lowering drug evolocumab helps high-risk patients reduce the likelihood of a heart attack or stroke, but its high cost raises questions about how many patients will benefit, researchers said last week.
The results of a 2-year clinical trial on the drug sold as Repatha by Amgen Phamaceuticals that costs more than US$14,000 a year were released at the American College of Cardiology annual conference in the US capital.
The randomized trial involved 27,564 people who had experienced a prior heart attack or stroke, or who had significantly clogged arteries that limited blood flow to their limbs.
Evolocumab reduced low-density lipoprotein (LDL), or “bad” cholesterol, by 59 percent.
It also decreased the risk of heart attack or stroke or cardiovascular death by 15 percent in the first year and 25 percent in the second year.
“The drug was safe and well-tolerated,” said lead study author Marc Sabatine, chair of cardiovascular medicine at Brigham and Women’s Hospital in Boston.
Experts not involved in the study described it as “exciting” and “major,” but urged caution due to the high cost of the medication.
“This is very expensive stuff,” said Valentin Fuster, physician in chief at Mt Sinai Medical Hospital in New York.
Fuster also noted that in absolute numbers, the drug saved about 2 percent of lives.
“We have to be very cautious in terms of the enthusiasm,” he told reporters at the conference.
Roxana Mehran, professor of medicine at Mount Sinai School of Medicine in New York, described the findings as “probably the most important trial here” at the ACC meeting, which is the largest annual gathering of cardiologists in the United States.
“Certainly America cannot afford to be giving this to every patient,” she added.
“While we don’t want to ration great care, we do need to figure out how to pay for this.”
New class
Evolocumab is part of a new class of drugs called PCSK9 inhibitors, which are monoclonal antibodies that help lower cholesterol.
Some patients who are unable to take traditional cholesterol-lowering drugs known as statins, due to their side effects, may be able to take PCSK9 inhibitors instead.
Patients report few side effects from Repatha, which acts differently than statins and does not cause the muscle pain and weakness that some statin users experience.
Repatha gained US Food and Drug Administration approval in 2015.
But its price, and the lack of data on its effectiveness until now, have limited its use.
“The biggest challenge is getting it covered by insurance,” Suzanne Steinbaum, director of women’s heart health at Lenox Hill Hospital in New York, said.
“When we see a trial like this, I think that the use is going to up exponentially,” she added, describing the study as “pretty exciting.”
“As demand and use goes up, the insurance companies usually follow,” Steinbaum said.
Heart disease and stroke are the number one killers worldwide, taking 15 million lives in 2015, according to the World Health Organization.
In the United States, heart disease accounts for one in every four deaths, and kills more than 600,000 people every year.
Stubbornly high cholesterol is a key risk factor.
The study showed evolocumab reduced LDL cholesterol by 59 percent, from a median of 92 to 30 mg/dL.
This made “a dramatic difference,” even if the drug could save just 2 percent of patients’ lives, said Kevin Marzo, chief of the division of cardiology at Winthrop-University Hospital in Mineola, New York, who was not involved in the study.
“In a disease that affects hundreds of thousands, that is a big difference, preventing a lot of heart attacks, a lot of urgent hospitalizations,” he said.
Financial analysts were more critical of the drug’s high cost, and Amgen shares fell 6.6 percent by midday, following the release of the study.
“At a cost of US$7,000 a year, this translates to US$958,000 per event saved,” Bernstein analyst Ronny Gal wrote in a note published by CNBC.
“Thus, in our view, payers will continue to restrict access to the drug.”
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