Possible Prescription-Tier Drop for Vytorin

Last week, GfK Market Measures released data charting the potential negative effect of the results of the ENHANCE trial on physician prescribing habits of Vytorin. Although many physicians haven't decided to drop the cholesterol-lowering drug altogether as a treatment option, some prescribers are being cautious in prescribing Vytorin for first- and second-line use.

ENHANCE pitted Vytorin—which combines the statin simvastatin (the active ingredient of Zocor) with Zetia (ezetimibe), a drug that blocks absorption of cholesterol in the gut—against a statin alone. In the study, Vytorin performed no better than a statin alone at reducing arterial plaque in a group of patients with severe congenital hypercholesteremia.

Of the 150 internists, general practitioners, and cardiologists interviewed, general practitioners said that they were less likely to prescribe Vytorin as a first-line drug, with a net change of -20 percent of patients. Use of Vytorin as a second-line medication is expected to drop across all specialties by 8 to 14 percent of patients. In third-line treatment, however, Vytorin prescriptions received a boost from 20 to 30 percent.

"The report shows that while patients are asking about the drugs, the physicians are not indicating that they are likely to quickly switch their patients off the drug, but they are indicating that they will switch how they prescribe the drug," said Anna Marie Napolitano, GfK vice president and category business leader, cardiovascular.

Some of the doctors told GfK that they might consider switching their first-line prescriptions to a generic or to Crestor. Since there is no indication of a safety issue, many are choosing to wait for more information to be released.

"It doesn't seem like there is going to be long-term pain for this brand," Napolitano told Pharm Exec on Friday. "I think [prescribers] are just going to ride it out and see what happens in the future. In the near term, it looks like doctors will back off on first-line prescribing and switch [back to Vytorin] down the line."