The word today is that AstraZeneca and Abbott are going to combine two of their cardiovascular therapies. Crestor, AZ's statin, and a new fibrate, the successor to Abbott's TriCor, will be sold as a single pill. Its name will, I feel sure, end in "-or". This is part of the next wave of cholesterol drugs (and drug mixtures), which are aiming to simultaneously lower LDL (via the statin) and raise HDL (the fibrate's contribution, in this case). A number of other "statin-plus-something-to-raise-HDL" projects are in the works (including a bet-hedging one from AstraZeneca with a totally different drug candidate from a small company called Atherogeneix).
As for these two components, Crestor is a powerful statin indeed, bordering perhaps on too powerful, and if it's possible to describe a billion-dollar drug has having disappointing sales, this is the one. (After all, if you listened to the analysts back before it was introduced, it was supposed to be selling three times that amount by now). And TriCor is a fibrate, one of a mechanistically baffling class of lipid-modifying drugs which have been in use for quite a while now. If you look through the literature, particularly in patent claims, you can see that the idea of combining statins and fibrates has been proposed many times before. It's a sensible combination, although (as with many of these ideas) it's something that you could probably also achieve by taking two separate medications. It would be interesting to know how many people are doing just that at present.
Another thing that would be worth knowing is how well this idea works with Abbott's next-generation fibrate compared to generic fenofibrate, and how well either one would work when combined with, say, generic simvastatin (Zocor) instead of (on-patent) Crestor. That's the flip side of these combination therapies - the insurance companies start to wonder if they can assemble the same sort of thing for a much lower price, and who can blame them? Of course, all this has already occurred to the various companies involved, who will be working hard to show that a single pill is better - that the dosing schedule makes a difference, that patient compliance is better, and so on. Everyone in this field is making sure not to miss any tricks.
AstraZeneca, for example, has been watching Merck and Schering-Plough do well with Vytorin, the combination of Zocor and the cholesterol absorption blocker Zetia, so they ran a trial of their own - Crestor and Zetia. That seems to have done very well indeed, although (as that Matthew Herper Forbes article points out), this was an open-label trial in patients with very high cholesterol numbers to start with.
But A-Z might find themselves arguing that patients should definitely go with a single pill when it's Crestor and the Abbott drug, oh yes, but to feel free to mix and match Crestor with Zetia. That'll be an interesting pitch. And things are just going to get more complicated as time goes on in this area. (Money will do that). But don't forget, the reason that there's so much money involved is that there are a lot of therapies that seem to have value. So it's nerve-wracking (but profitable) to be a drug company in this area, and it's tough to be an insurance company. But if you're a patient, well, it's not as bad as it used to be. . .
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