GP Survey Shows Concerns Over Tolerability Of Higher Dose Statins

Main Category: Statins
Also Included In: Primary Care / General Practice;  Cholesterol;  Cardiovascular / Cardiology
Article Date: 14 Nov 2008 - 4:00 PST

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According to the results of a new survey of 500 GPs across the UK, many GPs have concerns about the tolerability profile of higher doses of statins that are significant enough to affect their prescribing decisions.1 In the survey, which was conducted by TNS Healthcare UK and sponsored by Merck Sharp & Dohme Limited and Schering-Plough Limited, 40% of the GPs questioned about their use of simvastatin 40mg said they would not routinely increase the simvastatin dose to 80mg for patients that do not reach their lipid targets on the 40mg dose.1 Of these, 72% said this was due to tolerability concerns with 61% also noting the limited extra efficacy of the 80mg dose of simvastatin in comparison to the 40mg dose.1

This is despite the NICE Lipid Modification Guideline (CG 67) which states, for secondary prevention, that doctors should consider increasing to simvastatin 80mg or a drug of similar efficacy and cost if lipid targets for high risk patients are not reached on simvastatin 40mg.2

Additional results from the survey show that 67% of GPs believe that more than one in ten of their patients given the 80mg dose of simvastatin experience side effects that impact their compliance to treatment, with 34% estimating that at least one in every four patients is affected.1

Professor Mike Kirby, Visiting Professor, Faculty of Health and Human Sciences, University of Hertfordshire commented, "Getting patients to lipid targets is critical to reducing CVD rates in the UK but patients often need higher doses of statins to reach the levels set out by NICE. This survey brings to light the concerns held by many GPs about prescribing these doses. Higher dose statins have a place in treatment of patients at very high cardiovascular risk, such as those with familial hypercholesterolaemia, and for these patients, the benefits may outweigh the concerns about tolerability. But for those who fail to tolerate higher dose regimens, alternative approaches should be considered to ensure people can stay on treatment and reach their LDL-C targets."

Cardiovascular Disease (CVD) and CVD prevention in the UK

The NICE Guideline Development Group for the Lipid Modification Guideline (CG 67) highlights that CVD, which comprises coronary heart disease (CHD) and stroke, is the main cause of death in England and Wales, accounting for approximately 124,000 deaths in 2005.2

The NICE Lipid Modification Guideline recommends statin therapy as part of the management strategy for the primary prevention of CVD for adults who have a 20% or greater 10-year risk of developing CVD. Lipid targets for secondary prevention of CVD are total cholesterol <4 mmol/litre or LDL cholesterol <2 mmol/litre.2

About Merck Sharp & Dohme and Schering-Plough

- Merck Sharp & Dohme Limited and Schering-Plough Limited are partners in the development and marketing of prescription medicines in cholesterol management.

- Merck Sharp & Dohme Limited is the UK subsidiary of Merck & Co. Inc., of Whitehouse Station, New Jersey, USA, a leading research-based pharmaceutical company that discovers, develops, manufactures and markets a wide range of innovative pharmaceutical products to improve human health.

- Schering-Plough is an innovation-driven, science-centered global health care company. Through its own biopharmaceutical research and collaborations with partners, Schering-Plough creates therapies that help save and improve lives around the world. The company applies its research-and-development platform to human prescription, animal health and consumer health care products.

Schering-Plough's vision is to "Earn Trust, Every Day" with the doctors, patients, customers and other stakeholders served by its colleagues around the world. The company is based in Kenilworth, N.J., and its Web site is http://www.schering-plough.com.

References

1. TNS Healthcare UK. Survey conducted November 2008. Sponsored by Merck Sharp & Dohme and Schering-Plough.
2. National Institute for Clinical Excellence: Lipid modification (full clinical guideline 67), May 2008

Schering-Plough