Study authors noted that generic fibrates were widely prescribed in Canada, where they've been available for years, but that brand-name formulations continue to dominate U.S. prescribing, where they are "associated with a great economic burden for U.S. consumers and third-party payors," wrote Cynthia A. Jackevicius, an associate professor of pharmacy practice at Western University of Health Sciences in Pomona, Calif., and colleagues from the United States and Canada.
Dr. James H. Stein, director of preventive cardiology at the University of Wisconsin-Madison School of Medicine and Public Health, said most people don't realize the influence of marketing on health care. He said that negative studies about fibrates have been "spun to focus on the possible benefits" and cautioned that fenofibrate is associated with significant side effects, including "increased creatinine, which might indicate kidney dysfunction; gallstones, and more serious complications like pancreatitis, blood clots, and pulmonary embolism."
Dr. Cam Patterson, cardiology chief and physician-in-chief of the Center for Heart and Vascular Care at the University of North Carolina, Chapel Hill, said fibrates hold "a lot of promise, but so far that promise is unfulfilled." He, too, expressed concern about the ramifications of "recommending costly medications that don't confer real benefits to our patients. We've been burned before."
To date, "statins are the only cholesterol-lowering drugs that have been shown conclusively to save lives. Fibrates may be an option as add-on therapy, but there is no compelling case to use them as first-line therapy" for patients with elevated cholesterol. He said the substantial increase in fibrate use demonstrated "unfortunate tribal behavior by physicians that is no doubt driven by the big pharma marketing machinery."
Several doctors offered a more tempered view of fibrates. Dr. Christopher Cannon, a specialist in cardiovascular disease prevention at Brigham and Women's Hospital in Boston, said the drugs may not be effective in heart disease prevention, but have a role in reducing high triglycerides, which has become a bigger health concern "as the population has gotten obese."
Dr. Merle Myerson, an expert on lipid management who runs the Cardiovascular Disease Prevention Program at New York's St. Luke's-Roosevelt Hospital, cited circumstances where fibrate use is prudent, such as among patients who "cannot tolerate or do not want to take a statin," and suggested that one contributor to increased fibrate use might be that more doctors are aggressively treating high triglycerides among their obese patients.