July 23, 2007, 12:54 pm

Cholesterol Pills of a Different Feather Rise Together

Posted by Jacob Goldstein

Bucking a generic wave, a pair of brand-name cholesterol drugs
marketed jointly by Merck and Schering-Plough are growing briskly. The
companies said sales of the medicines climbed 30% for the second
quarter over the same period last year, to $1.2 billion.

Yet just last week, Pfizer said sales of its cholesterol-fighter
Lipitor fell 25% to $1.38 billion, battered by competition from
generic simvastatin, which Merck sold under the brand name Zocor.

Why the disparity? The drugs from Merck and Schering-Plough work
differently than Lipitor and simvastatin, and don't face direct
generic competition.

One of the drugs, Zetia, works in the digestive tract, rather than in
the liver, where statins such as Lipitor and simvastatin work. The
other drug, Vytorin, is a combination of Zetia and simvastatin.

"Part of the equation is affordability," said Michael Perskin, an
internist who teaches at NYU med school and is the general partner at
the Concorde Medical Group, told the Health Blog. "What drives a lot
of this is what the insurance company will pay for." That calculus
favors a generic statin, such as simvastatin.

"If it works really well and they tolerate it, you don't need a
combination drug." On the other hand, if a statin isn't causing any
side effects but isn't lowering a patient's cholesterol enough,
Perskin may try Vytorin, a potent pill that combines simvastatin and
the active ingredient in Zetia. (Perskin said he has been a paid
speaker for Pfizer, but hasn't been funded by other drug companies.)

He noted that a push last year to shift patients from branded statins
(such as Lipitor and Zocor) to generic simvastatin didn't affect his
prescriptions of Vytorin and Zetia, because there aren't generic
alternatives for those drugs.

URL: http://blogs.wsj.com/health/2007/07/23/cholesterol

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No comment.

Marilyn