Saturday, April 12, 2008

Snippets from the ACC in Chicago

There is always much news from Chicago as the ACC annual Scientific meeting is one of the biggest cardiac meeting in the world. From the Pharma marketing point of view, it makes sense to present all your trial results there. So it is not surprising that the big boys have come out with their big trials, just in time for Chicago. If one wishes to be polite, you can also say that premature conclusion of the trial was in the interest of patient care. Whatever it is, they got their results in time for ACC2008. Well, let me take you through a few trials that are of important to medical practice, not necessarily for interventionist.

1. ENHANCE TRIAL : Well, we wrote on this early. This is the trial that compared Zocor alone, against Vytorin ( zocor + exetimide) to see if it will regress plaques as measured by Carotid intimal thickness as measured by the ultrasound. Well, you all may remember that the trial ended in 2006 and the results were held back by the manufacturers ( MSD and Shering-Plough) and it took US Congressional intervention to make them produce the results. basically, the results were disappointing. Vytorin lowered LDL-C much more than zocor alone, but the carotid intimal thickness in both arms were basically the same, showing that Vytorin did no better than zoxor, in terms of plaque regression. Well, the full trial results were reported in ACC, and were what was revealed to us in Jan '08. Looks like Vytorin is dead (marketing-wise).

2. ON-TARGET : This was a large (25,600 patients) study comparing the use of Ramipril, against Telmisartan, and Ramipril+Telmisartan in the control of BP and major adverse cardiovascular events. Basically, it showed that Telmisartan, was no better the Ramipril or Ramipril+Telmisartan. And the Ramipril+Telmisartan arm had more adverse reaction. Basically, Ramipril is good enough. For those who cannot tolerate Ramipril, Telmisartan is a reasonable alternative. Looks like ACE-I is as good as ARB.

3. JUPITER : This study enrolled 15,000 normal healthy subjects with low LDL-C and high CRP, to see if Rosuvastatin 20mg, will lower the Hs-CRP and also major adverse cardiac events. This is one of those trial terminated prematurely, just in time for ACC 2008. Of course it showed that Rosuvastatin 20mg lowered Hs-CRP and also MACCE. Good for Rosuvastatin. Looks like AstraZ has a winner here.

4. HYPET : This trial enrolled 3,500 elderly hypertensives (age above 80years) to see if treatment with Indapamide SR, makes a difference. This is also one of those trials terminated prematurely, in time for ACC 2008. Well of course it showed that we should treat 80year old hyprtensives and that indapamide (natilix) SR is a good drug for this.

Well, I will stop here. There are obviously much more clinical trials reported. Be patient, not all in one go. Watch this page, ok?

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