Use of fibrates to lower cholesterol growing despite mounting evidence they don’t work

The use of fibrates and fenofibrates to reduce cholesterol levels has grown sharply in the United States over the past decade, despite mounting evidence that the drugs provide little benefit, researchers reported Tuesday. Moreover, physicians are increasingly prescribing brand-name versions of the drugs, such as TriCor and Trilipix, despite the fact that published evidence so far shows a benefit only for generic forms of the drugs, such as gemfibrozil, researchers reported in the Journal of the American Medical Assn.

The fibrates lower levels of so-called bad cholesterol and raise levels of good cholesterol. In general, however, they don’t lower levels of cholesterol as much as statins, which have been proved to be highly beneficial in preventing heart attacks and strokes. Two major studies, the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study in 2004 and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial in 2010 found that adding fibrates to statins did not reduce cardiovascular events more than statins alone. Nonetheless, fibrate prescriptions appear to be growing.

Pharmacologist Cynthia A. Jackevicius of the Western University of Health Sciences in Pomona and her colleagues used data from IMS Health, which monitors prescriptions, to examine trends in fibrate use in the United States and Canada. They found that the number of fibrate prescriptions more than doubled in the United States between January 2002 and December 2009, from 336 prescriptions per 100,000 population to 730 per 100,000. In Canada, in contrast, the number rose only from 402 per 100,000 to 474 per 100,000.

Prescriptions for fenofibrates, the newest form of the drugs, increased in the United States from 150 per 100,000 in 2002 to 440 per 100,000 by the end of 2009. That translated into a cost of $44,975 per 100,000 population per month. That increase occurred despite an absence of evidence that the brand name drugs are any better than generics, the authors said. The preference may arise, in part, they said, because the brand-name drugs can be taken only once per day, while generics must be taken twice per day. There is also a perception among doctors that the brand-name drugs are safer, although that has also not been proved, they said.