Blog | Tuesday, October 11, 2011

Disappointing results for Crestor

In my recent post All in for Crestor, I discussed how the SATURN study comparing Crestor to Lipitor was likely a make or break study for AstraZeneca's cholesterol pill. As mentioned, because Lipitor will soon go generic in November, AstraZeneca needed to give insurance companies a reason to pay for the more expensive branded pill, then the soon to be generic and cheaper version of Lipitor, which has been the number one selling drug in the country.

As reported in Pharmalot's post Disappointing Crestor results for AstraZeneca (see the official AstraZeneca statement here), the just released results of SATURN show that the 40 mg dose of Crestor was numerically but not statistically significantly better and reducing plaque build-up (as measured by percentage change) as the 80 mg dose of Lipitor. As secondary measure, plaque build-up as measured by volume was statistically significant, but since this was not the primary outcome of the study, it is likely enough for insurers to give Crestor a favorable status on their formulary lists.

Bottom line: Crestor is a great drug. It reduces low density lipoprotein (LDL) cholesterol better than Lipitor. We know that from outcome studies of all statins, that the lower the LDL with a statin, the more you decrease heart attacks and strokes. In addition, despite its potency, it has very good tolerability. Certain patients that might need 80 mg of Lipitor, might not be able to tolerate side effects at that high of a dose, and might end up doing better on 20 mg or 40 mg of Crestor. That said, starting in 2012, unless AstraZeneca cuts the price on Crestor drastically, it may be a challenge to get the prescription approved for patients.

Matthew Mintz, MD, is a Fellow of the American College of Physicians. He is board certified in internal medicine and has been practicing for more than a decade. He is also an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients. This post originally appeared at Dr. Mintz' Blog. Conflict-of-interest disclosures are available here.