Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that, in the treatment of dyslipidemia patients who fail to reach LDL goal, surveyed physicians are increasingly switching patients to a more potent statin --- most notably AstraZeneca's Crestor --- rather than adding Merck/Schering-Plough's Zetia (ezetimibe) or switching to Merck/Schering-Plough's Vytorin (simvastatin/ezetimibe). These changes have occurred as a result of the JUPITER trial as well as the ENHANCE and SEAS trials.
The new Physician & Payer Forum report entitled Vytorin One Year On: How Will Prescriber Attitudes and Payer Hurdles Influence the Markets for Dyslipidemia? finds that the share of patients prescribed Vytorin and Zetia by surveyed PCPs in primary prevention has declined by three and one percentage point respectively since the conclusion of the ENHANCE and SEAS clinical trials. However, in primary prevention, the share of patients prescribed Vytorin and Zetia by cardiologists has declined by seven and four percentage points respectively during the same time period.
The report also finds that a majority of managed care organizations' (MCOs) pharmacy directors have taken action as a result of the SEAS and ENHANCE trials. The ENHANCE trial showed that Vytorin was no more effective than the less expensive generic simvastatin in reducing carotid intima-media thickness. The report's survey results indicate that Vytorin was moved to a less favorable tier in 30 percent of both commercial plans and Medicare PDPs, although these actions may have been based on some misconceptions about Vytorin's efficacy.
"Although two-thirds of surveyed pharmacy directors indicate that they are aware of the results of the ENHANCE trial, their understanding of the results appears somewhat flawed and favors simvastatin," said Decision Resources Analyst Jeremy Goldman, M.D. "Only one-quarter of all surveyed pharmacy directors know that ENHANCE showed Vytorin was more effective at reducing LDL cholesterol than simvastatin. The negative press surrounding the results of the ENHANCE trial appears to have left an incorrect and unfavorable impression about Vytorin on many MCO pharmacy directors."
Vytorin One Year On: How Will Prescriber Attitudes and Payer Hurdles Influence the Markets for Dyslipidemia? is based on a U.S. survey of 70 primary care physicians, 70 cardiologists and 20 MCO pharmacy directors. Their responses were compared to assess similarities and differences of opinion regarding clinical, economic and scientific factors.
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