Hopes for 'Good' Cholesterol Drug Defy Bad Tests
RENEE MONTAGNE, host:
There is more bad news about a new drug that many hoped would change the practice of cardiology by raising what's known as good cholesterol.
Last December, the manufacturer halted tests of the drug in people after dozens died. And now a new study presented at the American College of Cardiology meeting in New Orleans shows the experimental drug doesn't even unclog arteries.
But as NPR's Joanne Silberner reports, scientists aren't counting the drug out yet.
JOANNE SILBERNER: Torcetrapib was supposed to be a billion-dollar drug for Pfizer. It works in an unusual way: It raises good cholesterol, HDL. Statins lower LDL, the bad cholesterol. Torcetrapib was supposed to be the next big thing, says Dr. Steven Nissen, president of the American College of Cardiology. But then, last December...
Dr. STEVEN NISSEN (President, American College of Cardiology): An ongoing, long-term clinical trial that was looking at the effect of this HDL-raising drug was stopped prematurely because there were more deaths in the group that got the drug than the group that got a sugar pill or a placebo.
SILBERNER: Now you might think that would be the end of it. But Nissen and other researchers had already collected data on 900 patients who had taken torcetrapib, and some of it looked very good.
Dr. NISSEN: The half of the patients that received torcetrapib had a 61 percent increase in HDL, or good cholesterol, and an additional 20 percent decline in LDL, or bad cholesterol.
SILBERNER: Those are stunningly good numbers to any cardiologist. But the real Question, of course, is does the drug keep arteries from clogging? It does not. When Nissen and his colleagues compared people taking both a statin and torcetrapib to people taking just a statin, they found no difference.
Dr. NISSEN: It's terribly disappointing.
SILBERNER: A study from another group produced the same finding. So the drug doesn't reduce hardening of the arteries, and it also kills some people. Still, cardiologist Antonio Gotto says research into similar drugs should go on carefully. Gotto was a former head of the American Heart Association.
Dr. ANTONIO GOTTO (Dean, Weill Cornell Medical College of Cornell University): The question then and the question remains now is whether or not this is an effect due to this specific chemical entity, torcetrapib, or whether or not it represents this class of drugs.
SILBERNER: A related but non-identical chemical might have the good effects without the toxic ones. Indeed, Pfizer is testing such a drug, and Merck and Roche are working on their own candidates. What keeps the research going is the need for something to offer patients when statins aren't enough. Again, Steven Nissen.
Dr. NISSEN: We've had good drugs for 20 years, and we've lowered the risk of heart attack, stroke and death by about 30 percent. But we still have a disease that's the number one cause of death in both men and women.
SILBERNER: And the example of Bacol is never far from cardiologists' minds. Bacol was a statin drug that caused extreme muscle cramping and 31 deaths and had to be taken off the market.
Dr. NISSEN: What if Bacol had been the first statin drug developed? What if we had said, well, this entire class of drugs just won't work?
SILBERNER: That would have meant no statins. So Nissen and others are going to continue to work with the HDL-raising drugs.
Dr. NISSEN: It's two strikes for torcetrapib, but it's not quite a strikeout yet.
SILBERNER: Joanne Silberner, NPR News.
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