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Bad news about their cholesterol drugs can't keep Merck reps down

ORLANDO — Merck & Co. took a hit last weekend when a new study cast doubt on whether two of its blockbuster cholesterol drugs help patients avoid heart attacks and strokes.

But at the major medical meeting in Orlando, where the study was released, the mood Monday was resolutely upbeat as Merck and other pharmaceutical giants focused on selling their wares to more than 20,000 cardiologists and other health professionals from around the world.

"Can't talk," a smiling, dark-suited Merck representative told a reporter as he stood under brightly lit banners for Zetia and Vytorin, the drugs in question. A flame-red, arterylike pillar accented the Merck booth while an espresso machine hissed in the background.

The American Heart Association's annual "Scientific Sessions," held this year in Orlando, are a big draw for both doctors and drug companies, with more than 200 pharmaceutical and medical device companies filling the exhibit hall. Part science, part circus, the show combines cutting-edge research symposia with trade-show shilling. Another plus: nightly dinners with continuing education credits where pharma companies pick up the tab.

The cavernous exhibit floor, dubbed "The Science and Technology Hall," featured an inflatable, walk-through mega-heart (see a mitral valve prolapse!), a "healthy lifestyles" section anchored by Hershey's ("dark chocolate is good for you") and endless rows of eye-catching drug company displays.

At the Plavix booth, sales reps worked the crowd while an overhead screen showed blobs of plaque winding down a sinuous red artery in need of a blood thinner.

AstraZeneca's Crestor had its name up in lights, along with a reminder that it had the "lowest average co-pay compared to Lipitor and Vytorin."

Pfizer touted both its best-selling cholesterol drug Lipitor and smoking-cessation pill Chantix. Docs waited in line for the Pfizer giveaway: Get your photo taken in a lab coat and we'll put it on a poster for your office.

On Monday, thousands of cardiologists crowded the convention's main hall to hear results of a study that was accidentally leaked by an Indiana TV station and picked up nationally a day earlier. The findings: Merck's Zetia was not as effective as Abbott's Niaspan in reducing plaque buildup in the carotid artery for patients on statins. Niaspan, which costs about the same as Zetia ($3 to $4 a day), is an extended-release version of the inexpensive vitamin niacin.

The report, also published in the New England Journal of Medicine, was definitely not good news for Merck, which had its top scientific officers on site to handle damage control. Zetia and Vytorin, a combination of Zetia and the statin Zocor, are among the company's most popular prescription drugs, with worldwide sales last year totaling $4.6 billion.

Merck officials quickly dismissed the study, which followed about 200 patients over 14 months, as too small to be meaningful. But even a reviewer who was critical of the early termination of the trial concluded that it showed "clear superiority of niacin over ezetimibe (Zetia)."

For many cardiologists, the research, the third such negative study, was just one more nail in the coffin for Merck's drugs, which reduce cholesterol but have not been proved to prevent heart attacks and strokes, as low-cost statins do.

Sitting outside the auditorium Monday, Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, criticized Merck for spending billions to market its drugs, rather than proving their effectiveness. Though Zetia went on the market in 2002, results of a company-funded study of its impact on heart attack incidence are not expected until 2012 at the earliest.

"They want us to give Zetia on faith, while there's a lot of evidence that statins work," Nissen said. "That's not acceptable."

Back in the exhibit hall, Merck's sales force kept smiling. Their neighbors at Abbott, just across the carpeted aisle, looked even happier.

Kris Hundley can be reached at or (727) 892-2996.

Bad news about their cholesterol drugs can't keep Merck reps down 11/17/09 [Last modified: Wednesday, November 18, 2009 7:49pm]
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