Introduction:
Treatment for dyslipidemia is focused on the use of HMG-CoA
reductase inhibitors (statins) to limit the synthesis of cholesterol and
increase the clearance of low-density lipoprotein cholesterol (LDL-C) to reduce
the risk of cardiovascular disease. Our analysis of newly diagnosed patients
shows that Pfizer’s Lipitor (atorvastatin) and simvastatin lead all agents in
patient share in the first three lines of treatment, while AstraZeneca’s
Crestor (rosuvastatin) continues to gain ground following initial safety
concerns at its launch in 2002. Adjunctive agents remain an important component
of treatment for those patients who are not able to reach lower LDL-C targets
or who have additional lipid abnormalities (i.e., low high-density lipoprotein cholesterol
[HDL-C], elevated triglycerides). Until January 2008, Merck & Co./Schering-Plough’s
Zetia was the preeminent adjunct therapy in early-line usage owing to its
combination of synergistic efficacy with statins and good tolerability in
lowering LDL-C. However, Zetia’s momentum has been halted following the
publication of the ENHANCE trial, which called into question the efficacy of
the agent in preventing clinical events. Our analysis integrates patient-level
claims data and insight from 162 surveyed U.S. cardiologists and PCPs to
determine how concerns over Zetia and Merck & Co./Schering-Plough’s
Zetia/simvastatin FDC (Vytorin) have changed the dyslipidemia market through
in-depth comparisons with our 2008 data. This report determines the share of
each currently marketed drug by line of therapy, analyzes why key drugs are
chosen over others, which agents have benefited from the ENHANCE trial fallout,
and explains how physicians predict their behaviors and prescribing habits will
change over the next two years with the recent launches of Abbott’s Simcor and Abbott/Solvay’s
TriLipix and the impending launches of Abbott/AstraZeneca’s Crestor/TriLipix
FDC and Kowa’s Livalo.
Questions Answered in This Report:
*
Simvastatin
has overtaken Lipitor as the single agent with the greatest patient share in
newly diagnosed patients.
What is the treatment initiation rate for newly diagnosed dyslipidemia
patients, and what are the major barriers to initiating treatment? What are the
retention rates for early-line treatments, including differences between
Lipitor and simvastatin? When do physicians turn to adjuncts, and how does the
early-line patient share for Zetia compare with Abbott’s Tricor and other fibrates?
How has this share changed since the publication of ENHANCE?
*
Pathways to key
therapies: Longitudinal claims data reveal which agents of a given class are
placed ahead of other agents in lines of therapy.
How are Crestor and Lipitor positioned relative to
each other in lines of therapy? When do physicians turn to fibrates, and what could
limit the uptake of TriLipix in the dyslipidemia market? What drugs precede the
use of Niaspan, and what does this say about how physicians use this agent?
*
Physician
behavior: Dyslipidemia patients are treated by both cardiologists and PCPs; the
reasons physicians give for changing treatment from a given agent differ
between the two types of treating physicians.
What factors influence each specialty when making
drug choices? What attributes are most critical in differentiating between Tricor
and TriLipix, and between Tricor and Niaspan? What do surveyed cardiologists
versus PCPs view as the differential advantages of Lipitor, Crestor, and
simvastatin? What are physicians most likely to do upon failure of the leading statins
(i.e., how many switch to a different agent before increasing the dose or adding
an adjunct)?
*
Forecast: Many surveyed
physicians say they will increasingly strive for aggressive LDL-C targets and
increase their use of agents to target HDL-C and triglycerides in second-line
therapy.
For which drug classes
do physicians anticipate writing more prescriptions over the next two years?
How do the anticipated changes of cardiologists differ from PCPs? Will ENHANCE
continue to change prescribing habits over the next two years? What impact will
the patent expirations of Lipitor and Tricor have on the dyslipidemia market? Will
Kowa’s statin Livalo see significant uptake? How many physicians are
anticipating prescribing Abbott/AstraZeneca’s Crestor/TriLipix FDC versus
Kowa’s emerging statin Livalo?Scope:
Primary research: Quantitative results from our
survey of 162 physicians (80 cardiologists and 82 PCPs):
- Physician opinion on how drug use differs by patient severity.
- Most influential drug attributes when physicians choose between
agents.
- Anticipated changes in the line of therapy in which physicians
use key agents.
Primary patient-level data: Quantitative findings
from our analysis of data covering 61 million lives from 98 geographically
diverse U.S. health plans:
- Quantified lines of therapy analysis showing exact share of each
agent in each line of therapy, including rate of progression between lines and
length of time patients are on each line.
- Progression flowcharts through one year of treatment for newly
diagnosed patients receiving each of the following first-line agents:
Lipitor, Crestor, simvastatin, Novartis’s Lescol, lovastatin, pravastatin,
Zetia, Abbott’s Tricor, Abbott’s Niaspan, Daiichi Sanko’s Welchol, Pfizer’s Colestid,
Vytorin, Pfizer’s Caduet, Abbott’s Advicor, gemfibrozil, generic fenofibrate,
other fenofibrate brands, cholestyramine, cholestryamine light.
- Flowcharts tracking the preceding therapy patterns for patients
taking each of the following key therapies: Lipitor, Crestor, simvastatin,
Lescol, lovastatin, pravastatin, Zetia, Tricor, Niaspan, Welchol, GlaxoSmithKline’s
Lovaza, Vytorin, Caduet, Simcor.