Tuesday, 27 October 2015

Evacetrapib - please try harder

The world of lipidology is a surreal one, where many intelligent people run around with a serious tone in their voice and a set of guidelines – busily allotting humans into categories of:

·         pretty good, but you can do better,
·         not good, but don’t worry, we’ll fix you; and
·         how are you still alive?

Then, with the utmost surety, the smart people who know better than you, prescribe various forms of diet and drugs. There is no room for uncertainty in this world – blood fat is where it’s at.

The internet is littered with forums and blogs where people compare numbers and rejoice when LDL is low or feel like a failure when it is not. Jealousy over someone else’s numbers is both common and bizarre. Even people who claim not to ascribe to the lipid hypothesis get rather animated when a particular number is not where it is supposed to be.

“I thought the lipid hypothesis was bullshit, but then my LDL number got a bit too high for my liking…so I started believing and became a born again vegan”.

Or something to that effect.

That makes about as much sense to me as the previously staunch atheists who, after being jailed for life or sentenced to death, suddenly find God. I'm all for hedging bets, but ignoring your instincts and then crucifying your self-respect to do it, seems a little silly.

As it happens, my last visit to a GP ended in him giving me a prescription for atorvastatin and a suggestion that I should stop using the internet for information. Honestly, that is exactly what he said. I discarded both items of advice because (a) I’m in denial…der, and (b) I reckon I could have taken him if it came down to a wrestling match where he tried to stuff pills down my throat and poke my eyes out.

Which brings me to Evacetrapib, the Cholesterol Ester Transfer Protein Inhibitor that had lipidologists holding their breath, expecting the ridiculously named wonder drug to lead us all to squeaky-clean-artery-nirvana. 

You see, CETP Inhibitors have a miraculous ability to lower LDL-C and increase HDL-C, which also happens to be the equivalent of a lipidologist’s wet dream. The fact that CETP Inhibitors have not exactly set the world on fire, despite their magical ability to produce ‘wonderful lipids’, didn’t stop the crew at Eli Lilly from giving it a good crack. 

Pfizer tried their hardest with Torcetrapib, but, despite it working well, it had the unfortunate side effect of death in some people. Hoffman-La Roche came up to bat with Dalcetrapib, with very disappointing, albeit vague, results. Eli Lilly have now stopped phase 3 trials of Evacetrapib becausethere was a low probability the study would achieve its primary endpoint based on results to date.”

What exactly that means, hopefully we’ll eventually find out, but in the interim all it means is the share price of Lilly takes a good whack. For a group of Japanese trial participants, it certainly resulted in massive increases to HDL and significant reduction in LDL – that these didn't result in “primary endpoints” is a little confusing. What does a pharma company have to do to get some bloody results, for Odin’s sake? Lipidology black magic is not enough?

Not to worry, though, because Merck is hoping to be the Steven Bradbury of lipidology, with “encouraging” progress on Anacetrapib. That the drug remains in your system 4 years after you stop taking it, shouldn't give you reason to be a Captain Killjoy. 

In other news:
The equivalent of 4 cigars laced with asbestos