All GLG News Analyses Filed Under: Cardiology

Stent Oligopoly: bigger stakes, bigger trials.

October 20, 2008

Analysis by: GLG Expert Contributor

Analysis of:Health Firms to Study Clots in Stent Patients | online.wsj.com

This collaboration will be very successful: the trial involving 20 000 patients will take a long time to complete. During the trial utilization of stents will not change. Upon completion of the trial it will become even more obvious that 2 years of "blood thinning" is better than 1 year for stents potency rates. The complications of prolonged "blood thinning", however, will promote search for a safer "blood thinner".

Amiodarone is here to stay.

October 20, 2008

Analysis by: GLG Expert Contributor

Analysis of:Wyeth Heart Drug Not A Short-Term Option | www.pharmalot.com

Amiodarone is still one of the best drugs for atrial fibrillation despite "rare incidence" of cirrhosis, lung fibrosis and now "rare muscle injury".

Medtronic: chasing the tail.

October 20, 2008

Analysis by: GLG Expert Contributor

Analysis of:Medtronic Endeavor Heart Stent Tied to Complications | www.bloomberg.com

Utilization of a device in a setting of marginal data is not driven by that data, but by the reimbursement rates. Medtronc might loose the battle, but stents are still winning the war.

Successful Collaboration Is Better Than Individual Failure

October 20, 2008

Analysis by: GLG Expert Contributor

Analysis of:Health Firms to Study Clots in Stent Patients | online.wsj.com

This plan to start a large trial to determine the optimal antiplatelet therapy. after [drug-eluting] stent implantation makes sense both scientifically and economically for the involved stent companies (Johnson & Johnson, Boston Scientific, Medtronic and Abbott). Sanofi-Aventis and Bristol Myers Squibb, who market clopidogrel (Plavix) are likely also interested to have more precise data out there about the issue, before the rival compound, prasugrel, gets FDA approval. The optimal length and intensity of antiplatelet therapy after drug-eluting stent placement is not known and the trial will be specifically designed to answer this question.

End of Era: Abbott's Attempt.

October 14, 2008

Analysis by: GLG Expert Contributor

Analysis of:Abbott: Clinical trial shows stent 'does its job' | www.forbes.com

Currently, bioabsorbable stents do not provide better solution than traditional stents for the major problems of early thrombosis and absence of long term advantage compared with medical management (in appropriate patients).

Joseph BertinoIndependent ConsultantBertino Consulting

Gene Targeted Drug Therapy for Heart Failure

September 23, 2008

Analysis of:Gene Targeted Drug Therapy for Heart Failure | www.bio-medicine.org

-Another step towards invididualized medicine -Proves that old drugs can be reinvented for useful purposes -Advances pharmacogenetics forward

COURAGE - flawed trial as it compares optimum medical therapy with sub-optimum PCI

September 11, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

There are major issues that need to be remembered when generalising the results of COURAGE trial 1.Patients with high grade anginal symptoms and strongly positive stress tests were excluded. Thus the COURAGE data applies to only the low risk subset of chronic stable angina 2. Optimum medical treatment with excellent compliance was employed in the medical treatment arm but sub-optimal treatment in the PCI arm - plain balloon angioplasty and bare metal stents. Though this may not matter in terms of mortality (though meta-analysis of registry data do show mortality benefit of DES over BMS), they would certainly matter in terms of MACE 3.69% of patients had multi-vessel disease and the revascularisation strategy in them -especially the diabetic subset- may have been CABG rather than PCI. Thus the revascularisation strategy in the majority of patients may have been in-appropriate

The trial that is all about hype

August 28, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

The general public hears the bullet that stents are no better than medications, but the reality that this trial (COURAGE trial) had major flaws, the main being that only 10% of the patients screened participated in the trial. 90% were excluded. Thus, the patients enrolled were not necessarily the typical patients. Also, very few of the new, drug-eluting stents were used. That being said, the initial study, published in 2007, showed that stents were no better than medications in terms of reducing deaths of myocardial infarctions. This second report suggests that in this particular group of patients, the stents are not better at reducing chest pain/improving quality of life.

Minimal Impact on Stent Market

August 21, 2008

Analysis by: GLG Expert Contributor

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

Because equivalent results were shown, there will be no change in stent placement volumes.

Marc HametClinical ProfessorCOLUMBIA UNIVERSITY

Its all about the spin

August 21, 2008

Analysis of:Heart Stents No Better Than Drugs for Chest Pain Over Time | www.bloomberg.com

This article could easily be spun as a victory for stent efficacy.

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