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THIS PILL COULD REDUCE THE CHANCE OF A HEART ATTACK
The anticholesterol drug Mevacor was already generating nearly $1 billion in sales annually for Merck & Co. Then came word of a study that suggests strongly that the drug can curb a leading cause of heart attacks. The drug packs such a punch against the fatty arterial deposits known as plaque that the scientists conducting the study announced on Nov. 20 that they had canceled plans to extend their research for another year and a half.
The study, conducted for Merck by the University of Southern California, won't be published until next year, but early word of the findings is expected to convince even skeptical physicians that the drug is worth using. While physicians argue about the value of reducing high cholesterol levels, many heart specialists are sure that halting the accumulation of plaque will go far to stem heart disease. "For cardiologists, this is the type of evidence that means a great deal," says Dr. Basil M. Rifkind, a physician with the National Heart, Lung & Blood Institute. One Denver cardiologist, Dr. Lester Lockspeiser, adds that this work, if it holds up in scientific reviews, "may go a long way" toward changing the minds of hesitant general practitioners.
The good news comes just when Merck -- and a shaky stock market -- needed some. Growth in new prescriptions of Mevacor has flattened over the past six months, settling into a range of some 220,000 to 230,000 in new patient prescriptions per month in the U. S., according to independent industry analyst Hemant K. Shah. What's more, Bristol-Myers Squibb Co. recently rolled out a competing medication, Pravachol, which should cut into Mevacor's market. "This is going to give Merck another boost," says Shah. Merck did no more than confirm that the study had been halted. That was enough for investors: Merck stock shot to 145, up 6 1/8, on Nov. 20.
The growth potential for Mevacor is huge. Only about 3 million of an estimated 10 million to 21 million Americans with worrisome cholesterol levels are taking some kind of medication, Merck officials say. And many are taking drugs that come in an inconvenient form or have harsh side effects (table). Even with its $500 to $700 annual price tag and the lifetime commitment to daily use patients must make, Mevacor is becoming a favorite. Unlike some competing medicines that require mixing a powder into water or other liquid, Mevacor pills are "easy to take," says Dr. Daniel Steinberg, a University of California at San Diego physician who monitored the new study.
The USC research is the first to show that a single drug can halt the buildup of plaque. And in a small share of users, it can actually shrink fatty deposits. Earlier studies, including one in 1987 by Dr. David H. Blankenhorn, leader of the USC team, have used two or more drugs in combination, along with diet changes. One such project, conducted last year by Dr. B. Greg Brown of the University of Washington, paired Mevacor with colestipol, a powdered drug, or with niacin, a vitamin. All the studies concluded that reducing cholesterol can halt or reverse plaque build-up.
VEGGIE DIET. In the new study, patients took four times the normal dose of Mevacor. Results were so good after two years of testing on more than 240 patients that Steinberg's monitoring committee concluded it was no longer ethical to continue giving placebos to some high-risk patients. "It was clear that the drug is beneficial," says Steinberg.
Not all experts are thrilled about the preliminary results. Some say that most of the estimated 50 million Americans who should mind their cholesterol would be better off reducing the fat in their diets. Says Dr. Edwin L. Bierman, a medical professor and expert on atherosclerosis at the University of Washington: "The first line of treatment is not everybody taking a drug for life, but going to a low saturated-fat diet." He points to a recent study that shows that people can fight arterial plaque simply by switching to a nearly all-vegetarian diet.
For Merck, however, the results are likely to be powerful medicine. The study, once it's reviewed by experts and published, would bolster a claim that Mevacor can help prevent heart attacks. That would put sales back on the fast track -- and keep Merck among the healthiest players in the drug industry.
MEVACOR AT A GLANCE
GENERIC NAME: Lovastatin
COST: $500 to $700 yearly for once-a-day use
USUAL DOSAGE: 20 mg
PURPOSE: Cholesterol reduction, but a new study suggests that it can help
prevent heart attacks
SALES: Nearly $1 billion annually
PLUSES: Few side effects, compared with the bloating, flushing, and
gastrointestinal distress common to rival drugs
PROBLEMS: Pravachol, new from Bristol-Myers Squibb, has just begun competing
head to head. And Merck may compete against itself with Zocor, due out soon
DATA: COMPANY REPORTS, BWJoseph Weber in Philadelphia