Showing posts with label torcetrapib. Show all posts
Showing posts with label torcetrapib. Show all posts

Saturday, November 16, 2013

The Cardiologist Giveth, then the Cardiologist Taketh Away: Revision of the Cholesterol Guidelines

There has been quite a stir this week with the publication of the newest revision of the ACC/AHA guidelines for the treatment of cholesterol.  The New York Times is awash with articles summarizing or opining on the changes and many of the authors are perspicacious observers:
As the old Spanish proverb states, "rio revuelto, ganancia de pescadores" - when the river is stirred up, the fishermen benefit.  I will admit that I'm gloating a bit since I consider the new guidelines to be a tacit affirmative nod to several posts on the topic of the cholesterol hypothesis (CH).  (More posts here and here and here, among several others - search for "cholesterol" or "causal pathways" on the Medical Evidence Blog search bar.)

Wednesday, March 26, 2008

Torcetrapib, Ezetimibe, and Surrogate Endpoints: A Cautionary Tale

In today's JAMA, (http://jama.ama-assn.org/cgi/content/extract/299/12/1474 ), Drs. Psaty and Lumley echo many of the points on this blog over the last six months about ezetimibe and torcetrapib (see posts below.) While they stop short of calling for a boycott of ezetimibe, and their perspective on torcetrapib is tempered by Pfizer's early conduct of a trial with hard outcomes as endpoints, their commentary underscores the dangers inherent in the long-standing practice of almost unquestioningly accepting the validy of "established" surrogate endpoints. The time to re-examine the validity of surrogate endpoints such as glycemic control, LDL, HDL, and blood pressure is now. Agents to treat these maladies are abundant and widely accessible, so potential delays in discovery and approval of new agents is no longer a suitable argument for a "fast track" approval process for new agents. We have seen time and again that such "fast tracks" are nothing more than expressways to profit for Big Pharma.

Psaty and Lumley's chronology of the studies of ezitimibe and their timing are themselves timely and should refocus needed scrutiny on the role of pharmaceutical companies as the stewards of scientific data and discovery.