A head-to-head study on the combination cholesterol-lowering drug, Inegy, has shown that it could be more effective than one of its main rivals, Crestor.

Launched in the UK in 2005 and in the US in 2004, it was one of the worlds fastest-growing major products last year with sales at around $1 billion.

Inegy, (a combination of ezetimibe and simvastatin) is co-marketed by Schering-Plough and Merck and is the first tablet to simultaneously block the production of LDL or bad cholesterol in the liver and also its absorption into the bloodstream via the intestine.

The results of a study of 2,949 patients, comparing Inegy with AstraZeneca's statin, Crestor (rosuvastatin), which acts solely by blocking liver production of LDL, were unveiled at the International Symposium on Atherosclerosis in Rome.

The study found that across all dose comparisons, Inegy had a 4.2% greater cholesterol reduction from baseline compared to Crestor.

Researchers also looked at those patients in the study with high risk factors and found that Inegy was superior to Crestor in lowering bad cholesterol levels within this group, reducing them by 68.5%, compared with Crestor, which gave a 50% reduction. Schering-Plough said the study also showed that Inegy provided significantly greater lipid reduction compared to Crestor when averaged across all doses.

Alberico Catapano, professor of pharmacology at Milan University and author of the study, said: "Many patients with high cholesterol do not meet such goals using a recommended statin dose  even with a highly effective statin. These patients may require an increase in statin dose, but doubling a statin dose yields on average only a six per cent greater reduction in cholesterol."

He added: "This study shows that clinicians can set a new standard in cholesterol reduction by treating two sources of cholesterol using enzetimibe/simvastatin, thus providing patients with significantly greater bad cholesterol control."

Prof Catapano noted the warning contained in a report issued by the leading pan-European think tank, The Stockholm Network, which stated that there will be "significant, policy, health and economic consequences" by the year 2020 if high cholesterol levels "are not better managed today".

He said: "The medical community should heed these warnings, recognise that optimal bad cholesterol control and goal attainment is imperative and improve management of all patients  particularly those with several risk factors."  

pharmafocus@wiley.co.uk