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To the Editor: Dr. Davidson concludes his article saying “we should remember [that ezetimibe] is safe and well-tolerated.” Yet, he admits there is a lack of outcomes data for the drug. So, how does he know it is safe if we don’t have the mortality outcomes? The just-published Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial indicated that there may be an increase in cancer mortality.1 The point is that we need more data. Until we have that outcomes data we should not be saying a drug is safe as a matter of fact. Physicians need to learn the lessons we should have learned from drugs such as torcetrapib2 or erythropoietin3 and so many others. We often think we are doing a good thing by correcting lab values, but we often learn too late that we harmed the patient at a staggering ethical and financial cost.

Dr. Davidson also references the impressive LDL-C lowering of Senator McCain while taking ezetimibe. Senator McCain has a publicized history of melanoma. Hopefully, ezetimibe doesn’t increase his cancer mortality risk because his physicians are proud of his LDL-C lowering. My advice to the senator is to use one of the many other proven methods of LDL-C lowering until there is good mortality outcome data with ezetimibe (but I’m not a Republican, so he may want to get a second opinion).

References
  1. Rossebø AB, Pedersen TR, Boman K, et al, for the SEAS Investigators. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 10.1056/NEJMoa0804602.
  2. Barter PJ, Caulfield M, Eriksson M, et al. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357:2109–2122.
  3. Wright JR, Ung YC, Julian JA, et al. Randomized, doubleblind, placebo-controlled trial of erythropoietin in nonsmall-cell lung cancer with disease-related anemia. J Clin Oncol 2007; 25:1027–1032.
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Gil Porat, MD
Penrose Hospital, Colorado Springs, CO

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To the Editor: Dr. Davidson concludes his article saying “we should remember [that ezetimibe] is safe and well-tolerated.” Yet, he admits there is a lack of outcomes data for the drug. So, how does he know it is safe if we don’t have the mortality outcomes? The just-published Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial indicated that there may be an increase in cancer mortality.1 The point is that we need more data. Until we have that outcomes data we should not be saying a drug is safe as a matter of fact. Physicians need to learn the lessons we should have learned from drugs such as torcetrapib2 or erythropoietin3 and so many others. We often think we are doing a good thing by correcting lab values, but we often learn too late that we harmed the patient at a staggering ethical and financial cost.

Dr. Davidson also references the impressive LDL-C lowering of Senator McCain while taking ezetimibe. Senator McCain has a publicized history of melanoma. Hopefully, ezetimibe doesn’t increase his cancer mortality risk because his physicians are proud of his LDL-C lowering. My advice to the senator is to use one of the many other proven methods of LDL-C lowering until there is good mortality outcome data with ezetimibe (but I’m not a Republican, so he may want to get a second opinion).

To the Editor: Dr. Davidson concludes his article saying “we should remember [that ezetimibe] is safe and well-tolerated.” Yet, he admits there is a lack of outcomes data for the drug. So, how does he know it is safe if we don’t have the mortality outcomes? The just-published Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial indicated that there may be an increase in cancer mortality.1 The point is that we need more data. Until we have that outcomes data we should not be saying a drug is safe as a matter of fact. Physicians need to learn the lessons we should have learned from drugs such as torcetrapib2 or erythropoietin3 and so many others. We often think we are doing a good thing by correcting lab values, but we often learn too late that we harmed the patient at a staggering ethical and financial cost.

Dr. Davidson also references the impressive LDL-C lowering of Senator McCain while taking ezetimibe. Senator McCain has a publicized history of melanoma. Hopefully, ezetimibe doesn’t increase his cancer mortality risk because his physicians are proud of his LDL-C lowering. My advice to the senator is to use one of the many other proven methods of LDL-C lowering until there is good mortality outcome data with ezetimibe (but I’m not a Republican, so he may want to get a second opinion).

References
  1. Rossebø AB, Pedersen TR, Boman K, et al, for the SEAS Investigators. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 10.1056/NEJMoa0804602.
  2. Barter PJ, Caulfield M, Eriksson M, et al. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357:2109–2122.
  3. Wright JR, Ung YC, Julian JA, et al. Randomized, doubleblind, placebo-controlled trial of erythropoietin in nonsmall-cell lung cancer with disease-related anemia. J Clin Oncol 2007; 25:1027–1032.
References
  1. Rossebø AB, Pedersen TR, Boman K, et al, for the SEAS Investigators. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 10.1056/NEJMoa0804602.
  2. Barter PJ, Caulfield M, Eriksson M, et al. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357:2109–2122.
  3. Wright JR, Ung YC, Julian JA, et al. Randomized, doubleblind, placebo-controlled trial of erythropoietin in nonsmall-cell lung cancer with disease-related anemia. J Clin Oncol 2007; 25:1027–1032.
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