New drug may help GPs to meet NSF cholesterol targets
Government policy advisers have flagged up a new cholesterol-lowering drug that could have a 'highly significant' impact on meeting national service framework targets.
The National Horizon Scanning Centre, a Department of Health-funded unit that alerts policymakers to new and emerging technologies, released a report earlier this month on ezetimibe (Ezetrol) the first in a new class of drug called cholesterol absorption inhibitors.
It called for a detailed evaluation of the therapy because of the number of patients it could benefit and the likely impact on prescribing budgets. Ezetrol costs around £1 per day.
The advisers said the drug, launched last month, could be the answer for GPs failing to control cholesterol levels in patients using statins alone.
They cited studies showing ezetimibe can reduce cholesterol by 32 per cent when
co-administered with a statin compared with 13 per cent
using a statin alone.
GP experts agreed 'add-on' drugs were needed in patients who failed to meet the national service framework cholesterol target of 5mmol/l and argued any increase in cost could be offset when simvastatin comes off patent.
Dr John Pittard, an adviser to the national service framework for coronary heart disease, said the National Institute for Clinical Excellence would probably review add-on statin therapies.
Dr Pittard, a GP in Staines, Middlesex, said GPs should use ezetimibe in patients who did not respond to maximum statin doses of 40mg per day and in patients who could not tolerate statins. 'You could switch statins or drop the dose and add ezetimibe.'
Step-wise increases in statin dose could produce a reduction in cholesterol of 6 per cent whereas adding ezetimibe would gain a reduction of 18 per cent, he added.
Dr Peter Fellows, chair of the GPC prescribing sub-committee, said add-on cholesterol- lowering drugs were essential for meeting cholesterol targets, especially as the Joint British Societies were set to recommend lower targets of 4mmol/l later this year.
But Dr Fellows, a GP in Lydney, Gloucestershire, warn- ed: 'Until there is very clear guidance and very clear evidence of the benefits it's difficult to justify the huge expense there might be with widespread use of add-ons.'