Re: What about VYTORIN?

From: David Rind (drind_at_caregroup.harvard.edu)
Date: 12/04/04 

Date: Fri, 03 Dec 2004 22:44:27 -0500

Steve Marcus wrote:
>>Rind:
>>Actually, I think you could go further than that. There's no published
>>evidence that ezitimibe, one part of the combination being discussed,
>>has any clinical benefits either alone or in combination with other
>>drugs for cholesterol. It has been shown to reduce LDL levels, but that
>>is not the same as showing that it has a favorable effect on clinical
>>outcomes. (There are no trials showing it doesn't have clinical
>>benefits
>>either. No clinical endpoint trials have been published.)
>
>
> And again, that's about as disingenuous a post as one is likely to read on
> Usenet. First, Zetia, (ezitimibe) _has_ been shown to block absorption of
> cholesterol in the digestive tract. Second, reduction of LDL levels _has_
> been shown, *in general*, to produce favorable effects on clinical outcomes;
> there's no need to show that reduction of LDL _by ezitimibe_ produces
> favorable effects on clinical outcomes.

I don't normally read sci.med.cardiology, so I just bumped into this.
I'll crosspost to sci.med in case there are responses.

What exactly is "disingenuous" about my post. I honestly believe we need
clinical trials of ezitimibe. You write that reduction of LDL levels in
general has been shown to have favorable clinical effects. Okay, please
point to a single primary prevention trial of lowering LDL, using a drug
other than a statin, that showed overall favorable effects on mortality.
I can point to several such trials that showed no benefit on mortality
and at least one that showed a statistically significant increase in
mortality.

Before the statins, we had no evidence that using cholesterol-lowering
drugs for primary prevention is good. We still have no evidence for any
drugs other than that statins. Again, what exactly is disingenuous about
asking for some clinical-endpoint trials of ezitimibe? Post some data
rather than insults. 

-- 
David Rind
drind@caregroup.harvard.edu