Choles­terol medicine cuts heart at­tack risk

But not for as many peo­ple as promised by very costly drug.

Austin American-Statesman - - NEWS - By Mar­i­lynn Mar­chione

A long-act­ing choles­terol medicine cut the risk of hav­ing a heart at­tack and some other se­ri­ous prob­lems by 15 to 20 per­cent in a big study that’s likely to spur fresh de­bate about what drugs should cost.

Statins such as Lip­i­tor and Crestor are cheap and lower LDL or bad choles­terol, but some peo­ple can’t tol­er­ate or get enough help from them. The new drug, Am­gen’s Repatha, is given as a shot once or twice a month and is part of a novel class of medicines that have an un­prece­dented ef­fect on LDL lev­els.

It costs more than $14,000 a year, and in­sur­ers have balked at pay­ing that price with­out proof that Repatha low­ers heart risks, not just the choles­terol number. The new study pro­vides that ev­i­dence, but the ben­e­fit is not as great as some doc­tors had hoped.

For ev­ery 200 peo­ple treated with Repatha for roughly two years, three fewer peo­ple would suf­fer a heart at­tack, stroke or heart-re­lated death, the study con­cluded. But looked at by them­selves, deaths were not re­duced by the drug.

“That’s a big ben­e­fit,” said Dr. Marc Sa­ba­tine, the study leader, from Brigham and Women’s Hos­pi­tal in Bos­ton. But Dr. Don­ald Lloy­dJones, pre­ven­tive medicine chief at North­west­ern Univer­sity and an Amer­i­can Heart As­so­ci­a­tion spokesman, called the re­sults mod­est and “not quite what we hoped or ex­pected.”

Dr. Mark Hlatky, a Stan­ford Univer­sity car­di­ol­o­gist and cost ef­fec­tive­ness re­searcher, said, “peo­ple were hop­ing for a break­through, a lot big­ger re­sult than 20 per­cent.”

For pa­tients like Su­san Goodreds, whose in­sur­ance co­pay for Repatha is $356 a month, it’s not an easy choice.

“It’s an ex­pen­sive, ex­pen­sive drug,” the 74-year-old Florida woman said. “You have to make some real de­ci­sions about whether to stay on it.”

The re­sults were pub­lished Fri­day by the New Eng­land Jour­nal of Medicine.

Repatha and a sim­i­lar drug, Pralu­ent, were ap­proved in 2015 for peo­ple with in­her­ited risk for high choles­terol, or heart dis­ease that had al­ready caused a prob­lem such as a heart at­tack. The study tested Repatha in more than 27,500 peo­ple who had LDL above 70 (the rec­om­mended up­per limit for such pa­tients) de­spite max­i­mum statin use.

After about two years, Repatha, used along with statins, re­duced LDL to a me­dian of 30 from 92. It also proved safe.

Repatha cut by 20 per­cent the com­bined risk of hav­ing ei­ther a heart at­tack, stroke or a heart-re­lated death. The ben­e­fit grew with longer use, and was 25 per­cent the sec­ond year, said Sa­ba­tine, who con­sults for Am­gen and other drug­mak­ers.

The drug cut by 15 per­cent a broader set of prob­lems, in­clud­ing hos­pi­tal­iza­tion for chest pain or an artery-open­ing pro­ce­dure.

This last re­sult is some­thing in­sur­ers care about: pre­vent­ing costly health care. But does the drug pro­vide enough sav­ings to jus­tify its price?

“That’s the big­gest is­sue — whether they’re worth all the money,” Hlatky said of the drugs. If they cost 50 times as much as statins, “are they 50 times bet­ter? I don’t think so.”

ROBERT DAWSON / AM­GEN / VIA AS­SO­CI­ATED PRESS

Am­gen’s Repatha, seen here, cut the chances of hav­ing a heart at­tack or some other se­ri­ous prob­lems by 15 per­cent to 20 per­cent in a study of high-risk pa­tients, a study showed.

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