newsletter Statins The first patents for some of the group of drugs known as statins (cholesterol- lowering drugs) will shortly be expiring. This will set a market segment in motion that is important both from an economic and insurance perspective. Avoidable causes High cholesterol ranks number seven of death;
on the list of avoidable causes of death (see table). 4. Tobacco
therapies
The market segment for cholesterol-lowering
generating
drugs is predictably large. In 2002, worldwide
largest revenues sales of cholesterol- and lipid-lowering
* The review tracks actual sales of approximately 90% of all prescription drugs and some over-
the-counter products in more than 80 countries. Reference: IMS Health Report, 2002
Cholesterol-
There are currently two ways of treating a high cholesterol level: by improving
lowering; statins one’s diet or by undergoing medical treatment with cholesterol synthesis
inhibitors (CSE inhibitors, statins), nicotinic acid or ion exchangers. In the case of
medical treatment, statins constitute the most important group of drugs. The
first active substance (lovastatin) was brought onto the market in 1989. In 2002
sales of atorvastatin (Pfizer; USD 8.6 billion) and simvastatin (Merck; USD 6.2
billion) were larger than for any other prescription drug worldwide (see overview
2002 [US $billion]
3. Omeprazole (Losec®/Prilosec®) AstraZeneca Anti-ulcerant
Mode of action
Statins are specific inhibitors of the key enzyme in cholesterol biosynthesis
(HMG-CoA reductase). The inhibition of this enzyme reduces the level of
cholesterol synthesis taking place in the cells, particularly liver cells. This, in
turn, results in more low-density lipoprotein-bound cholesterol (LDL or “bad“
cholesterol) being absorbed into the cell from the blood, thereby reducing the
amount of LDL cholesterol by 30-40%. This significantly reduces the likelihood
of a patient succumbing to a vascular wall disorder and suffering resulting health
impairments such as heart attack or stroke. A projection of the results of various
studies revealed that treating risk patients with statins could prevent
approximately 9,000 deaths in Germany every year.
Side effects:
Ever since the first clinical studies were carried out in the early 1980s, the
rhabdomyolysis
medical profession has been aware that statins may, in rare instances, lead to
rhabdomyolysis, causing striated muscle fibres in the body to disintegrate. The
catabolites from this process may cause damage to the kidneys and other
organs. Kidney failure, in particular, may result in death. This risk may be
amplified in cases where patients consume a combined dose of statins and
fibrates (lipid-lowering medication). As a higher occurrence rate of this disease
was observed in patients taking cerivastatin (Lipobay®, Baycol®, Zenas®) –
usually in larger doses or in combination with the fibrate gemfibrocil – than in
those being treated with other statins, this active substance was voluntarily
withdrawn from the market in August 2001.
Patent expiry:
In 2003 the patents for simvastatin and lovastatin will expire in May and June
simvastatin,
respectively. This means that two active substances, which are highly attractive
lovastatin
from a commercial point of view, are shortly to become available generically.
Hexal and Betapharma will be the first companies to launch products using
simvastatin preparations (brand names: Simvahexal® or Simvabeta®) under
licence agreements. Others will enter the market once the patents have expired.
Reference: Arznei-telegramm 2003, Jg. 34, Nr.3
Simvastatin is one of the statins that has been researched the most
comprehensively. Its effectiveness as a drug was established in the important
“4S-Study“ (Scandinavian Simvastatin Survival Study) involving 4,444 patients
who had already suffered a heart attack or were suffering from a coronary
disease. The study, which was conducted over a period of five years, indicated a
reduction in risk (number of deaths) from 11.5 % to 8.2 %. Subsequent studies
on this or similar statins – including some that were carried out on patients that
demonstrated high levels of fatty substances in their blood but had no record of
heart disease – produced comparable risk reductions.
Rosuvastatin
Rosuvastatin (Crestor®), also referred to as a “superstatin“, is a new product, the
(Crestor®)
effects of which are alleged be positive both for patients and doctors. To date,
the clinical development programme for Crestor® includes more than 15,000
patients that have taken part in a series of comparative studies. Crestor® has
proven to be more effective than other previously prescribed statins (ator-
vastatin, simvastatin and pravastatin) as a means of lowering the LDL cholesterol
level in the blood. Furthermore, dose adjustments are required less frequently.
The manufacturers (Astra Zeneca) admit, however, that the total incidence and
severity of clinically relevant, undesired side effects resulting from rosuvastatin
is comparable to that of other statins currently available. The Food and Drug
Administration (FDA) has delayed issuing an approval to market the drug in the
US and is demanding more data: it has expressed safety concerns, notably in
connection with the health effects of large doses. Rosuvastatin is currently
approved for sale in Canada and Holland.
Conclusions
The patents for the statins simvastatin and lovastatin are due to expire in the
near future, making them available as generic drugs. In the case of simvastatin,
this means that a blockbuster drug will become available generically.
Rosuvastatin, promoted as a “superstatin”, is a new active substance in this
group. It is authorised for sale in Canada and Holland and is likely to be approved
Information for
Generally speaking, insurers should treat statins critically. This is of particular
the underwriter
importance in the case of the commonly prescribed combined dose treatments
involving fibrates, as the withdrawal of cerivastatin (Baycol®, Lipobay®) from the
In the near future several companies will be bringing products that contain
simvastatin or lovastatin onto the market. This increases the accumulation risk
for the insurer, as a larger number of products and companies will be impacted
In the case of “rosuvastatin“ we have not yet had sufficient experience to
determine the risk accurately. If the drug is approved for sale in other countries
and new studies become available, we should re-evaluate our position with
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