Doctors Rethinking Prescribing Abbott's Niaspan

From Chicago Tribune (IL) (May 31, 2011)


May 31--Doctors say they are thinking twice about prescribing an Abbott Laboratories drug used to raise levels of good cholesterol to patients taking a statin pill that is successfully lowering their bad cholesterol.

The change of heart by physicians about the need for Abbott's Niaspan follows the release last week of a National Institutes of Health study that showed the drug failed to prevent heart attacks and slightly raised the risk of a stroke when combined with the popular generic cholesterol pill simvastatin, also known by the brand name Zocor.

Doctors say statins, including simvastatin, Lipitor and Crestor, do such a good job at lowering LDL, or bad cholesterol, that there's often little need to add another pill to most patients' treatment. And the study is giving them more reason not to add Niaspan, which raises HDL, or the good stuff.

"An incremental benefit of adding another agent to something that works very powerfully is very hard to show," said Dr. Alan Brown, a cardiologist and director of the lipid clinic at Midwest Heart Specialists, a large cardiology practice in Chicago's western suburbs. "If you are already on a statin and your LDL is at its target, does adding niacin (the active ingredient in Niaspan) give you any additional benefit? Based on the study, there is not much of a benefit."

An estimated 1 in 7 Americans have high cholesterol, a major risk for cardiovascular disease, which kills 800,000 Americans annually. Statins have helped people combat heart disease by reducing the LDL (low-density lipoprotein) cholesterol that contributes to plaque buildup in arteries. They thus play into a long decline in the number of heart surgeries, according to American Heart Association statistics.

"We really are dealing with a drug class that has profoundly changed the history of heart disease," Dr. Clyde Yancy, chief of cardiology at Northwestern Memorial Hospital in Chicago, said of statins.

"Up to this study, there was thought that adding Niaspan to a statin would give additional benefit to reducing cardiac events," said Dr. Matthew Sorrentino, a cardiologist of University of Chicago Medical Center. "This study showed it gave no benefit and may even cause harm. I think physicians are going to think twice about giving it."

Doctors did not find Niaspan's slight stroke risk to be a major concern, and they pointed out benefits, including raising HDL (high-density lipoprotein) cholesterol, that they believe help reduce the risk of heart attack, particularly for patients intolerant of statins. In addition, doctors say Niaspan reduces the risk of unrelated pancreatitis.

For its part, Abbott said in a statement to the Tribune that the stroke risk finding was "inconsistent" with prior Niaspan study results. "No stroke safety signals have been seen in post-marketing safety data."

"It's likely there will be some degree of impact to Niaspan sales," said Abbott spokesman Scott Davies. Niaspan pulled in more than $900 million last year.

bjapsen@tribune.com

Twitter @brucejapsen

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Posted: May 2011


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