Time will tell, as it always does. I launched Lipitor and had responsibility for it all the way to LOE. This is not a Lipitor. And no, I’m not one of those old tired people that didn’t get hired, I didn’t apply, I’m retired. I really have gone back-and-forth as to exactly how this product might fit in. I really don’t see primary care using any of this drug at least not for the first 18-24 months. Obviously statins are first line, then add Zetia. Very few primary care providers are really fixed focused on the goals per se; if they had a patient on a mid range statin & Zetia and had reduced LDL by 50% they would feel just fine about it, no action required. Yes, there are statin intolerant patients; about 15%. Work arounds include switching to a hydrophilic statin adding CoQ10, or reducing statin dose and adding zetia. These strategies often work. PCPs will not interchange BA for zetia.
You MAY get some use from specialists; the good ones are more resolute in reaching below 70 LDLs. The same strategies apply regarding statins and zetia; if not at goal then I could see them adding BA.... maybe, or go to PCSK9 - These have been underutilized due to cost and Rx hassles, only 1/3 of PAs get approved and then only 1/2 of those patients actually buy the drug. Your saving grace may be cost-ease of use vs PCSK9s assuming you can get some plans to cover it (it will be step therapy for sure). But again its really tack hammer compared to Lipitor,Crestor, PCSK9s ,it wont get the job done for most specialists. Consider a CHD patient with starting LDL of 150. This would be a relatively mild patient. They are proven to be truly statin intolerant, So the choice is zetia + BA or PCSK9. Zetia/BA will reduce LDL by 40%, patient is not at goal. PCSK9 is 57%- patient at goal... No brainer.
I really do not see this drug fitting in very well. Time will tell, as it always does. I’m glad I’m not responsible for this.