News gets even worse for Vytorin and Zetia

Even more fall out today from the Enhance trial at the ACC today.

Anyone who follows the fortunes of the US pharmaceutical companies has heard of the trials and tribulations of Merck and Schering regarding the ENHANCE trial. As I have explained previously, this trial was a moderate sized trial comparing zocor to zocor plus zetia( this combination is sold as vytorin.) The trial was delayed and delayed again- and many of us assumed and still believe that the companies where trying to suppress the results. Two months ago, the data was released to the press. Zetia showed no benefit in slowing the progression of atherosclerosis of the carotid arteries.   The sales of the drug fell a little (about 20%) but not as much as some of us expected. My colleagues who still used the drug told me that they still wanted to see the data officially presented before changing their prescription patterns.

Today the data was officially presented and discussed at the ACC. The forum was the first plenary session of this year’s ACC meeting- just after a particularly poor talk by the President of the ACC about nothing in particular. The room must at McCormack Place in Chicago must fit 20,000 and it was standing room only. After a 9 minute presentation of the data- most of which we were all familiar with, the fun began. The panel of distinguished cardiologists gave their opinions of the trial. Any lingering suspicions that Merck and Schering could buy their way out of this jam( They do both give generously to the “ACC”and ads for Vytorin and Zetia hang throughout the conference hall and can be seen in the daily newspaper of the meeting.) I cannot remember such a negative presentation. Krumholtz( a well respected Cardiologist at Yale) spoke at great length about how this drug was massively overused, and how he felt that the only open question was whether it should be used as a third line drug or not at all. Comparisions to torceptrapib abounded( this was the failed drug from Pfizer last year which also improved choledterol but seemed to increase death and heart attacks. 

After the talk, I headed over the the Zetia/Vytorin booth in the vendor section of the meeting. It was eerily empty. Not even a line for the fresh squeezed OJ.

I have short positions in both Merck and SGP (I went short Friday morning when the stocks were up in anticipation of positive PR out of the meeting) and suspect I will do very well when the market opens tomorrow. SGP can fall quite a ways from here- they are not very well diversified. Merck may be a buy once it gets into the high 30s. 

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  • Chowdry

    March 31, 2008

    Did you know something the rest of us didn't. I am a family doc and was told by those "honest" drug reps that it was study familial hypercholesterolemia where LDL's were 300, and they were looking for regression by IVUS, as we all know you really wont see regression in plaque unless you are below 100 ideally below 70.

    Now I guess it was smoke and mirrors by the drug reps

  • pharmaking

    March 31, 2008

    The LDLs were in fact 300 and they are probably right that regression would require a very low LDL. Still, one woul expect at least less progression in the trial arm where the LDL was lowered by an additional 50 points.
    The Merck and Schering reps are clever, but I would never describe them as honest. They pulled the same tricks with Vioxx for years after the VIGOR trial. I dont listen to anything they say.

  • pharmaking

    March 31, 2008

    I forgot to link my older articles on zetia and vytorin.

    I am pretty proud of my calls on this.

  • JRodgers

    March 31, 2008

    What about AZN? Isn't it very cheap in light of this news and their own Crestor news?

  • pharmaking

    April 01, 2008

    Good point I just published an article suggesting that. I am buying AZN heavily today.

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