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Will
I have to go with KC and STS on this ....suggest you do not launch an attack on Dr Wood .
He is highly respected
AK
Actually I can see how you would get a higher number because of under reporting of scrips ....but how do you factor in cost of the coupon program ( or do you ? )
AK
MD and Biochia
Not sure I understand your math here .
The retail cost per 30 day scrip at Walgreens is $231.99...so if Bio's scrip numbers hold for the rest of June , you are at about $9,719,787 for the qt .
How do you factor in the cost of the coupon program to the company ? My insurance won't pay for it so I 'm spending $134.32 a month for 30 day supply .
AK
Will
Isn't Ad Com standard proceedure for a new indication ( approving Vacepa for mixed
dyslipidemia ) ?
AK
Will
Investigating Dr Wood ?
Suggest you don't mess with the Scots , Will
AK
Thanks for the link to him tho , interesting read
Will
What's your take on the following
AMRN used AZN's Crestor in their combo trial...so you would think a natural win win partnership for an Anchor launch , but AZN bt Omthera .
There must have been talks going on there .
Care to speculate what happened
AK
funnygl2 thanks for posting the scrip spread sheet
AK
Dew
Thanks for the feedback . Your insight is much appreciated
One thing I would add tho ...combo drugs usually show higher compliance ..The Ultimate trial.... and there appears to be a sygnegistic ? benefit when combined with a statin ( as per Williams research ) that might enable some of us to reduce the amount or statins we take .
Anyone on max dose statins would love to find a way to reduce their statin intake and still meet their lipid targets .....Vascepa might enable that.
By the way ...I've been on max dose statins since about 1987 ...taken practically every kind of statin , Fibrates and Niacin etc ....Vascepa I am finding to be the most patient friendly drug I've ever taken to ( hopefully ) reduce my risk of a heart attack .
Akanz
Due
I would be interested in your comments on Mercks new drug Liptruzet ( combination of Zetia and a generic Lipitor. Cost wise to the patients it looks like Merck is almost throwing in the statin for free as long as you take the Zetia , at full price , with it
Would AMRN be able to do something similar with Vascepa and a generic Lipitor ?
JL re " Akanz -what are you talking about re resolvins "
JL I'm just reading your research on AA/EPA , inflammation and so on so I can at least try and fake a semi informed conversation with some of my clients , neighbors , parents at my youngest school.
Akanz
Ok Will , take a few deep breaths here ......the research you and JL have been doing is interesting to read but predicting what the FDA will do .....?....carefull now
AK
Zum
Thanks for the article --interesting note " the most potent antioxidant capacity was observed with EPA and the active metabolite of atorvaststin ( Lipitor )
AK
Hi Ajax
Wasn't the Jupiter trial with Crestor mostly about lowering high hsCrp ( inflammation )
and
Anything to stop AMRN doing a combo with Lipitor ( now off patent ) , like Merck did with Zetia for their new drug Liptruzet.
Liptruzet has a fixed dose of 10mg Zetia combined with 10 up to 80 mg of Lipitor
AK
Zuma
Great post
Anything that safely enables CAD patients to reduce the amount of statins they are taking is of great value .
When on max dose statins you are very aware of muscle cramps , memory loss and risk of Diabetes ....all of which can be reduced by taking lower doses.......so if Vascepa in a way enables patients to reduce their statin dose ....that would be great news.
AK
James --it won't be a boring summer if we keep getting the script growth figures we saw today .
Thanks to those who reported them .
AK
JL
" The rational for using EPA"
Please correct me if I am wrong but we won't really know if Vascepa ( or EPA) reduces CV events in a US population until we have results from the Reduce It Trial
I endured years of " The rational for using Niacin "....ie it improves all your lipids so you must use it ....since it improves your lipids it must reduce your risk ....so the story went until the Thrive Outcome trial sank that story .
Now , I am long Amarin and am now a discount card carrying Vascepa prescribed CAD patient ( CAD because of a cardiac cath showing plaque buildup )
How did I get my prescription for Vasepa ?
Kaiser refused until they see Outcome data
UCSF Adult Lipid Clinic refused for much the same reason plus they thought DS alternatives were almost as good
I finally " scored " with a client who was a Cardiologist who basically said " Listen , if you insist on taking 3 gms of a dietary supplement then at least take something that's FDA approved and safe ...I'll call in a scrip for you "
Now contrast with what it was like in my experience when Lipitor was launched ....not only was I given Lipitor free for 3 months ( provided I called in every month to UCSF to report on any side effects ) but my Primary Care MD also offered me free samples
Just telling you like it is ...at least in my experience on the left coast
Hope the weather clears up for you for golf this weekend ...hear it's been like the monsoon season on the East Coast
Akanz
Will
All I can say is that if London is impressed then I'm impressed that he's impressed.
Well done
AK
Zoo
Messaged you on YMB but in case you missed it ----I would continue taking V if I was diabetic ---you might google Clinical advances in type 2 diabetes and cardiovascular risk ... Dr Bhatt ( Reduce it trial )
AK
Thanks Ajax
Re Crestor
That confirms the opinion of those I talk to at UCSF ( and the reason I'm on it )
Akanz
Hi Ajax
I'd be interested in your opinion of the Jupiter Trial using the statin Crestor .
It's used by some to support the case for using statins however the trial design ( and results ) has also been criticized by others .
Your thoughts ?
Akanz
Thanks Ajax
Sorry ...I'm on the basic message plan and can't ( as of now ) respond privately
I find it fascinating ( and I'm sure I'm not the only one ) to read the posts by JL and yourself .
Enjoy the weekend
Akanz
Hi Ajax
Your view re statins is pretty much the same as the co directors of the Adult Lipid center at UCSF....and they have published probably 200 articles on lipids / CAD ... Often in journals such as Current Opinion in Lipidology
To JL's point tho about how 50% of those experiencing an " event" have fairly normal cholesterol levels ...what causes those events ....inflammation , high blood pressure , high LpPla2 levels .??
I'd be interested in your opinion
Speaking as someone with a lipid disorder ....it's very helpful to read the posts by both you and JL .
Akanz
Thanks WM and GG
Yes I agree re Kaiser. I'm pushing the Kaiser C to see if he will bend at all --. Another Cardiologist I know initialy would only prescribe for TG's over 500 BUT now seems open to the idea to prescribe off label if I bug him enough.
I'm just trying to get a sense ( in a very small way ) as to wether or not MD's are becoming more comfortable with prescribing off label
Akanz
JL
I've never questioned your honesty and have often praised you for the information you have brought to this and other boards --- I have found it very useful.
My experiences on trying to get a script is simply that ---my experiences and yes I appear to have found a way around Kaiser's refusal to prescribe thanks to a friend/client who is a Cardiologist at a different hospital.
Hope its a good day for a round of golf in your area , I'm off for a run......enjoy the weekend.
Kiwi
Thanks JL
As regards to your comment
" if you have the problems you claim "
I've read your posts since 2010 ....I'm the longest living member of the male side of my fathers side of the family going back 3 generations ( my grandfather survived Galipoli but not his heart attack at 62 ....my father survived El Alamain ( WW11 ) but not his heart attack at aged 5O
I 'm well past BS
Kiwi
JL
Can't find the post you used to reply to me so I will use this one .
Here's a message from the front lines so to speak ---some one asking his Cardiologist for a script for Vascepa .
By the way while on max dose Lipitor ONLY my LDL was 181 , HDL was 29 and TG 212 --- classic mixed dyslididemia ( Anchor )I think
I had asked my Kaiser Cardiologist to read the Medscape article on EPA , Jelis , Reduce it ---had mentioned some of your comments
His response
" The Jelis trial benefit driven primarily by decreasing angina , not hard endpoints like death , heart attack , sudden death or heart attacks. Angina is not a usual endpoint for a cholesterol drug , and I suspect this has limited its widespread interest .
No I would not recommend this medication at this time "
So this is a real life example of what we are up against .
Besides saying he is not up to date on inflammation etc ----what are the best arguments you and anyone else reading this post , can make on why he should prescribe me Vascepa
Akanz
Hi Ajax ...yes agree , consensus favors Anchor approval
Re Livalol ...they want me to stay on the strongest statin for Lowering LDL ( as long as I can tolerate it ).. and that appears to be Crestor .
Thanks for the suggestion
AK
Zuma / Livin
Thanks ....don't actually have the scrip yet as it will be from a client / friend ( cardiologist ) whose is not my Kaiser Cardiologist. He suggested that I ask my Kaiser C to review the Medscape article and consider him a possible back up if Kaiser still refused .
My experience to date is the same as your friends ...but at least one of the Cardiologists I know is warming to the idea of prescribing off label because , as he wrote " it's FDA approved and safe "
Good luck ...looks like a good day for AMRN so far
Akanz
Thanks Ajax
I'll email my Cardiologist at Kaiser about it .....don't know if it's in their formulary and if it's as effective as Crestor at lowering LDL......but appreciate the advice .
Fortunately the cramping is not major and in my legs ....if it was upper body I'd be concerned as they warned me to alert them of first signs of that..
Very much appreciate the info that you , JL , Chab , Zuma and others provide to the board
Akanz
Zuma ---Wow lots of info , Thanks
The highest my LDL cholesterol has ever tested at was 312 !!! amazing
Which is why they have me on max statins , Zetia, no cholesterol diet , BMI under 25 , lots of exercise etc
And with all of that plus EPA have got my LDL down to 107 ---took 25yrs --- I'm a walking ( still ) example of the history of lipid management :)
Hope to knock a few more pts off with Vascepa
Ak
Hi JL
I'm betting on an Anchor approval which is why I am long AMRN ( its not a big position for me )
I think the Forbes article yesterday explains why the FDA is likely to approve and I've noted that at least one of the Cardiologists I know now appears willing to prescribe to me "off label " --so at least with those I know there is some shift in sentiment.
As regards to the science behind the benefits of EPA ... well I appreciate how you have explained and shared that with all of us ..and when I pass it on to those I know at the Adult Lipid Clinic at UCSF they simply say " Well lets see if it shows up in clinical benefit " ie actual reduction in events in a US population
They are hopeful but cautious ... and thats where I'm at .
Nevertheless I'll be taking Vascepa as soon as I get a script and maintaining my long position as long as script data trends upwards
All the best
Akanz
Hi Chab
Re sticking to the med in a trial .
If there ever was a med easy to stick to in a trial it's Vascepa . I was once in a trial for early Fibrates ( Cholestpol ? I think ) ...ghastly stuff . I was thinking that it may be because most in the trial will be on a lot of other meds as well. Dr Wientraub did say we should have results in 2-4 yrs .
The one problem I see tho is that if you were in this high risk group and could get a scrip for Vascepa anyway ...why would you want to take 50% chance of being on placebo .
When I was last interviewed ( by email ) for the trial ....that's what what I told them ...." not sure if I would stay in the trial if I could get a script "
AK
Thanks Study re the note on reps talking to Cardiologists ...but none of the Cardiologists I know will meet with a rep. They all refer to med journals , conferences etc
AK
WM
Yes I agree re Kaiser ....I'm pushing him to see if and when their opinions changes .
Missed your earlier question re LDL levels to 100 ....its one of the condition to meet to qualify for the Reduce it Trial , that and TG's over 150 , bypass or stents , diabetic etc
....Noticed in the Twitter duel between JNap and Adam F this afternoon that JNap thinks Reduce it will fail ....any comments anyone ?
Akanz
Ajax
Thanks for that post on Crestor ....definitely noticing a lot more cramping .
Sorry I missed some of the other posts ...
AK
Thanks Study
The one Cardiologists willing to prescribe explained " it takes awhile for ideas to perculate down " ...his words ..indicating an initial wait and see attitude followed by slow acceptance as he read the views of " thought leaders " in the field.
I know he reads The Heart.Org a lot and likely read the interview with Dr Christie Ballantyne on Heartwire
Akanz
Thanks Mitch , DRRC and Rich
I have access to 3 Cardiologists ( 3 different hospitals ) that could prescribe me Vascepa ....all initially refused to .
After reading the Medscape interview , one has now said he is willing to prescribe it to me on the basis that " it's safe and FDA approved "
I thought that change was note worthy as it may indicate more MD's willing to prescribe .
Akanz
Hi Chab
You provide great research by the way ...thanks .
So to continue on with my Kaiser Cardiologist email ....he wrote
"Treatment may be beneficial in patients with TG's over 500 . Vascepa is only recommended for patients with very elevated TG's above 500 "
I had been pushing him for a script as while on max dose Lipitor my TG's were still running in the low 200's and my HDL around 30 .....somewhat in the group that showed the most benefit in Jelis ...ie high TG with low HDL.......( this was before I started DS EPA and Crestor )
That email was a month ago .
I just sent him the Medscape article and will let you know if he has modified his position .
I'm pushing the " it's safe and FDA approved so why not " line ... has to be safer then the Dietary supplement EPA I'm currently taking .
Akanz
Lin
Thanks for posting the Forbes article
AK
Rich
Re levels of TG's to treat ...various opinions .
The following is an email from my Cardiologist at Kaiser
" Current recommendations for treating TG's have changed over the last couple years . Benefit has not been seen in drug treatment for mild or moderately elevated TG's ". ---explaining why he would not prescribe me V at the time.
Contrast that with the Adult Lipid Clinic at UCSF --- "based on your family history and other risk markers you need to keep your TG;s below 135 "
Two very different views ---- 3rd view today from another cardiologist as I mentioned in an earlier post ---after reading the Medscape article I sent him ,...showing safe and FDA approved .. would consider writing me a scrip for V if no one else will
Akanz
STS
Mtdsus wrote another post the next day on speaking with Joe Z
Different thread
AK