The battle of the cholesterol drugs has been declared a draw.
And given the rising cost of health care, the tie goes to the cheaper drug, experts say.
In a head-to-head test of two of the leading statins -- pills taken to lower cholesterol -- high doses of blockbuster drugs Lipitor and Crestor did about equally well, according to a study of 1,385 patients presented Tuesday at the annual meeting of the American Heart Association in Orlando.
Given that Lipitor, made by Pfizer, will soon be much cheaper than Crestor, the study could swing the massive market for cholesterol-lowering drugs, says Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill, who was not involved in the study.
Cholesterol medications are the leading class of prescription drugs in the USA at 255 million prescriptions a year. Lipitor -- the USA's best-selling drug, with sales of $7.2 billion last year -- will be available as a generic Dec. 1 at a fraction of its current cost.
AstraZeneca's Crestor "will be the last major statin not on patent," Patterson says. "The market for Crestor will go close to zero." It is now the No. 8 drug at $3.8 billion in annual sales.
After two years, about two-thirds of patients had less plaque in their arteries, according to the study, also published in The New England Journal of Medicine. Both drugs shrank the size of plaque in the coronary artery by about 1%. That's an "unprecedented" level, says study co-author Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic.
But Nehal Mehta, a cardiologist at the University of Pennsylvania School of Medicine, says there's no way to know whether such a small change actually prevents heart attacks or saves lives. And relatively few patients would even benefit that much. Only about 20% of patients are taking such high doses -- 40 milligrams daily of Crestor or 80 milligrams daily of Lipitor, says Mehta, who wasn't involved in the study.
The two drugs improved blood cholesterol levels by about the same amount as well.
Those on Crestor had a "bad cholesterol" (LDL) level of 63 milligrams per deciliter, and those who took Lipitor had a level of 70. Those who took Crestor had a "good cholesterol" (HDL) level of 50 milligrams per deciliter, vs. 49 for those on Lipitor.
Such minor differences in cholesterol levels are unlikely to affect heart-disease risk, Patterson says. "The bottom line is that there isn't a difference" between drugs, he says. "You should make your decision on other factors, like which one is least expensive."
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