Thursday, December 07, 2006

New HDL-Raising Medication Stopped in It's Track

Physicians and patients had been anticipating the outcome of the investigation trials for torcetrapib, an experimental medication which increases HDL (high density lipoprotein) or good cholesterol levels. However, this week the trials were stopped by Pfizer due to a higher death rate in the subjects who took this medication as opposed to those who did not.

Torcetrapib had gained much attention recently because there are no therapies which substantially raise HDL levels. Unlike the other cholesterols, HDL, helps protect against heart disease. A low level of HDL, less than 40 mg/dL for men and less than 50 mg/dL for women, is considered to be a significant risk factor for heart disease.

Most of the cholesterol lowering medications that are available currently do not effect the HDL significantly--they mostly lower the bad cholesterol or LDL (low density lipoprotein) levels. The therapeutic options for raising HDL are limited and mainly consist of regular exercise and niacin which often is not tolerated due to its side effect of a severe flushing sensation after taking the pill.

Normally, I would consider an experimental drug to be too esoteric for a blog, but I have had several knowledgeable patients who have asked me about its availability. For now, it's back to the drawing board. Torcetrapib has been terminated.

References: please see specific links.

5 comments:

Anonymous said...

The statement,."There are no therapies that substantially raise HDL levels,.." is wholly inaccurate & misleading. HDL2 is the "game", total HDL is FAR less specific.
Real free-nicotinic acid containing medication:
IR-Immediate release Niacin & ER-Niacin [Niaspan], {NOT SR-Niacin "Low Flush" [hepatotoxic] or Nicotinamide / aka NO FLUSH = placebo for lipids}, raise HDL2 113% to 189%. Recent data shows that total-HDL increases for up to 3 years on niacin. ONLY niacin & endogenous estrogen have this effect. The HDL increase is a pattern change in the total-HDL, primarily thru accumulation of HDL2. This is THE gold standard in HDL treatment,..and with IR or ER [NOT SR], it is safe. Flushing, with an EXPERIENCED clincian, is easily managed and almost always transient, usually subsiding after the titration period. Niacin already has a preponderance of data for MI, Stroke, Mortality & also the same benefit in diabetics. Counterintuitive to old 'dogma'.
It may be 3 years, or more, before ANY other therapy that EQUALS niacin is available. Evidence based medicine, outcomes data, in NUMEROUS NIH studies has already proven it`s benefit. Clinicians 'stall' on this, largely due to their reluctance to spend the 2-3 minutes to coach the patient adequately to empower them to succeed.
YES, a high-maintenance drug.
NO,.. it actually IS worth the trouble.
NEW SKILL SET REQUIRED:
PATIENT EDUCATION.

Dr. Taraneh Razavi said...

Dear anonymous
I agree that Niacin is the best medication that we have at this time for raising HDL. I would be interested in you sharing your experience and referring me to the data that shows that there is a 189% increase in the levels.

Anonymous said...

There is no way that there are reproducible studies showing 189% increase in HDL- even at a year out. Also, for those of us with experience using Niacin this has not been seen clinically either.

I do agree that No-Flush (which costs more) is useless as it contains no free Niacin. And it does take some time to explain how best to take the medication.

I also agree that there is great outcome data with Niacin. However it also affects TG and LDL levels, particle size etc- we therefore can't attribute this data soley to the effect on HDL.

Finally the tone of the post was aggressive. This blog is a place where not only patients can be informed, but where other docs can discuss medical issues as professional colleagues...sharing the info.

Anonymous said...

very thanks

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Fla-grp said...

There are several niacin studies, as well as a wealth of info re: niacin therapy at www.cholesterolscore.com