30 August 2015 - Doctors have long faced a conundrum in prescribing statins to lower cholesterol and heart attack risk: The drugs are cheap and effective for most people, and large, rigorous clinical trials have found minimal side effects. But as many as 25 percent of those who try them complain of muscle pain. Others stop taking the drugs because, they say, they cause a hazy memory or sleep problems, among other side effects not documented in studies.

Now, with the FDA approval on Thursday of the second in a powerful — and very expensive — new class of cholesterol-lowering drugs, the dilemma confronting doctors just got trickier. Should the people who need to lower their cholesterol, but say they cannot tolerate statins, be prescribed new drugs that cost more than $14,000 a year, potentially adding billions of dollars to the nation’s medical bill?

Doctors say their first responsibility is to patients, but it is hard for them or their patients to forget the price of drugs meant to be taken for a lifetime. The new drugs are approved for use by people with heart disease who cannot control their LDL, the dangerous cholesterol, by other means. Doctors say they try to work with patients to ensure that all who can safely take statins, many of which cost pennies a day, do so, but a substantial portion of patients insist the side effects are too severe.

For more details, go to: http://www.nytimes.com/2015/08/30/health/new-alternatives-to-statins-add-to-a-quandary-on-cholesterol.html

MAESTrO Insight: The PBAC considered a submission for evolucumab (Repatha) in July; the outcome is awaited with considerable interest.