The Atlanta Journal-Constitution
Cholesterol medicine cuts heart attack risk
But not for as many people as promised by very costly drug.
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 Lloyd-Jones, 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.”
‘People were hoping for ... a lot bigger result than 20 percent.’ Dr. Mark Hlatky Stanford University