Stakeholder Insight: Dyslipidemia - Titration versus Combination Therapy

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Publication Date: 2004-01-19

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Introduction
Datamonitor estimates that there are 307m people in the seven major markets with total cholesterol >200mg/dL and this is set to rise to 328m in 2011. However, despite this vast potential population, low diagnosis rates, the launch of generic statins and the maturing of the market mean that it is becoming increasingly important for companies to target the under-treated dyslipidemia sub-populations.

Scope

Examination of the dyslipidemia patient potential, detailing the current and future prevalence of high total cholesterol
Determination of the use of anti-dyslipidemics in dyslipidemia sub-populations and assessment of how treatment differs between each population
Assessment the current and future trends in the use of combination therapy and potential role and uptake of adjunctive therapies
Identification of the awareness, perception and expected future prescribing rates for new agents, such as Zetia (ezetimibe) and Crestor (rosuvastatin)

Highlights
Following recommendations from the American Diabetes Association, statins remain the first line therapy for diabetic dyslipidemia and findings from HPS and CARDS add to this evidence. However, some experts believe that results from DAIS and VA-HIT support the use of fibrates as the lipid-lowering agents of choice in diabetic dyslipidemics.

Although the use of combination therapy varies considerably across the seven major markets, this treatment strategy is becoming increasingly more common as treatment guidelines recommend more aggressive therapy in order to achieve lower target cholesterol goals and physicians remain reluctant to titrate statin doses.

For new anti-dyslipidemics to be successful, agents must have the potential to improve outcomes by improving efficacy, safety or both. Zetia and Crestor represent the newest therapies to be launched in the US and EU and, in general, the opinion leaders interviewed remain considerably more optimistic over the future uptake of Zetia than Crestor.

Why you should buy this report

Gain an independent view of the management of dyslipidemia and understand how physicians are influenced in their prescribing practices
Identify and quantify the 'difficult-to-treat' dyslipidemic populations and understand the differential treatment of dyslipidemia sub-populations
Recognize lucrative target populations, in terms of unmet need and patient potential, in order to successfully position developmental products

CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the dyslipidemia market - page 5
  - Summary - page 11
- Key metrics - page 12
TABLE OF CONTENTS - page 14
CHAPTER 2 INTRODUCTION AND SCOPE - page 25
- Coverage of the Stakeholder Insight Survey - page 26
CHAPTER 3 COUNTRY TREATMENT TREES - page 30
- Introduction to the treatment trees - page 30
- US - page 33
- Japan - page 40
- France - page 47
- Germany - page 54
- Italy - page 61
- Spain - page 68
- UK - page 75
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 82
- Disease definition and classification - page 82
  - Definition of dyslipidemia - page 82
  - NCEP treatment guidelines - page 82
- Epidemiology of dyslipidemia - page 84
  - US - page 86
  - Japan - page 87
  - France - page 87
  - Germany - page 88
  - Italy - page 88
  - Spain - page 89
  - UK - page 89
- Key patient segmentations - page 90
  - Segmentation by type of dyslipidemia - page 90
  - Familial hypercholesterolemia - page 93
  - Low HDL cholesterol - page 95
  - Segmentation by disease severity - page 100
- Co-morbidities and risk factors - page 102
  - Compliance among patients taking concomitant therapy - page 103
  - Dyslipidemia patients with obesity - page 104
  - Dyslipidemia patients with type 2 diabetes - page 105
CHAPTER 5 DIAGNOSIS AND TREATMENT RATES - page 108
- Diagnosis rates - page 108
- Who manages dyslipidemia? - page 111
- Treatment options - page 112
  - Overview of treatment rates - page 114
  - Comparison of treatment rates for dyslipidemia sub-populations - page 115
CHAPTER 6 OVERALL PRESCRIBING TRENDS - page 118
- Prescribing trends - page 118
  - Statin use in different dyslipidemia populations - page 119
  - Fibrate use in different dyslipidemia populations - page 124
  - Nicotinic acid derivative use in different dyslipidemia populations - page 129
  - Bile acid sequestrant use in different dyslipidemia populations - page 131
  - Fish oil derivative use in different dyslipidemia populations - page 135
  - Ezetimibe use in different dyslipidemia populations - page 137
  - Advicor use in different dyslipidemia populations - page 146
CHAPTER 7 ANALYSIS OF STATIN THERAPY - page 152
- Trends in statin therapy - page 152
  - Breakdown of statin prescribing by type of statin - page 152
  - Breakdown of statin prescribing by line of therapy - page 181
  - Breakdown of statin prescribing by daily dose - page 183
  - Brand versus generic statin prescribing: current and future trends - page 190
  - Limitations of statin therapy - page 202
CHAPTER 8 ANALYSIS OF FIBRATE THERAPY - page 209
- Trends in fibrate therapy - page 209
  - Breakdown of statin prescribing by type of statin - page 209
  - Changes in fibrate usage over recent years - page 213
CHAPTER 9 FIRST TO SECOND LINE THERAPY - page 214
- First line therapy - page 214
  - Breakdown of first line therapy by drug class - page 214
  - Breakdown of statins by compound at first line - page 216
- Second line therapy - page 220
  - Patients progressing to second line therapy - page 220
  - Breakdown of second line therapy by drug class - page 222
  - Patients progressing to third line therapy and beyond - page 225
- Changes in anti-dyslipidemic therapy - page 226
  - Patients having their drug therapy changed - page 226
  - Reasons for changes in therapy - page 228
  - Types of therapy changes - page 230
CHAPTER 10 ANALYSIS OF COMBINATION THERAPY - page 233
- Current and future prescribing of combination therapy - page 233
  - Proportion of patients receiving combination therapy - page 233
  - Future prescribing of combination therapy - page 236
- Breakdown of combination therapy - page 237
  - Statin + fibrate combination - page 239
  - Statin + nicotinic acid derivative combination - page 245
  - Statin + bile acid sequestrant combination - page 249
  - Statin + fish oil derivative combination - page 252
  - Statin + ezetimibe combination - page 254
  - Non-statin combinations - page 262
- Factors influencing future use of new adjunctive therapies - page 264
  - Incentives to prescribe adjunctive therapies - page 265
  - Disincentives to prescribe adjunctive therapies - page 268
CHAPTER 11 IMPROVING TREATMENT OUTCOMES - page 272
- Treatment outcomes - page 272
  - Patients failing to achieve target cholesterol goals - page 272
  - Factors influencing the prescribing of anti-dyslipidemics - page 279
CHAPTER 12 OTHER STAKEHOLDER INFLUENCES - page 285
- Regulatory perspectives: From approval to post-marketing - page 285
  - Delays in approval of new statins - page 285
  - Post-marketing surveillance of adverse events - page 287
- Payer/provider perspectives: Cost and reimbursement - page 288
  - The cost and reimbursement of Crestor - page 288
  - The cost and reimbursement of Zetia - page 289
  - Pricing of statins in Japan: the entry price of Livalo - page 290
- Pharmacist perspectives: Switching statins to OTC status - page 291
  - OTC statins: developments in the US and UK - page 291
- Patient perspectives: DTC advertising and consumer groups - page 298
  - The role of DTC advertising on patient demand - page 298
  - Increasing patient awareness through the media - page 299
CHAPTER 13 OPINION LEADER TRANSCRIPTS - page 302
- Prof Paul Durrington - page 302
  - Diagnosis and treatment - page 303
  - Statin therapy - page 306
  - Fibrate therapy - page 311
  - Combination therapy - page 312
  - Single pill combination therapies - page 315
  - Cross-risk factor single pill combination therapies - page 316
  - Treatment of diabetic dyslipidemia - page 317
  - Uptake of new therapies: Zetia (ezetimibe) and Crestor (rosuvastatin) - page 318
- Dr Tony Wierzbicki, UK - page 321
  - Diagnosis and treatment - page 322
  - Statin therapy - page 324
  - Fibrate therapy - page 329
  - Combination therapy - page 329
  - Single pill combination therapies - page 332
  - Cross-risk factor single pill combination therapies - page 333
  - Treatment of diabetic dyslipidemia - page 334
  - Uptake of new therapies: Zetia (ezetimibe) and Crestor (rosuvastatin) - page 335
- Prof Dan Atar - page 337
  - Diagnosis and treatment - page 338
  - Statin therapy - page 340
  - Fibrate therapy - page 345
  - Combination therapy - page 345
  - Single pill combination therapies - page 346
  - Cross-risk factor single pill combination therapies - page 347
  - Treatment of diabetic dyslipidemia - page 348
  - Uptake of new therapies: Zetia (ezetimibe) and Crestor (rosuvastatin) - page 348
- Dr Robert S. Rosenson - page 350
  - Diagnosis and treatment - page 351
  - Statin therapy - page 353
  - Fibrate therapy - page 360
  - Combination therapy - page 360
  - Single pill combination therapies - page 361
  - Cross-risk factor single pill combination therapies - page 362
  - Treatment of diabetic dyslipidemia - page 363
  - Uptake of new therapies: Zetia (ezetimibe) and Crestor (rosuvastatin) - page 365
- Bibliography - page 369
  - General and clinical trial data - page 369
- Epidemiology sources - page 374
  - US - page 374
  - Japan - page 374
  - France - page 374
  - Germany - page 375
  - Italy - page 375
  - Spain - page 375
  - UK - page 375
- Pricing sources - page 375
- Physician research methodology - page 376
  - Physician Sample breakdown - page 376
  - Physician questionnaire - page 379
  - Disclaimer - page 392

List of Tables
Table 1: Prevalence of total cholesterol >200mg/dL in the seven major markets (000s), 2003-2011 - page 12
Table 2: Key changes to lipid levels between the NCEP II and NCEP III guidelines - page 84
Table 3: Prevalence of total cholesterol >200mg/dL in the seven major markets (000s), 2003-2011 - page 85
Table 4: Prevalence of low HDL cholesterol (<40mg/dL) in England in 1998 - page 98
Table 5: Estimated proportion of dyslipidemia patients with co-morbid conditions and risk factors in the seven major markets, 2003 - page 102
Table 6: Framingham Heart Study data on lipid levels in men and women with and without diabetes - page 106
Table 7: Mean plasma lipid levels at diagnosis of type 2 diabetes in the UKPDS - page 106
Table 8: Estimated breakdown of the management of dyslipidemia in the general population by physician type, 2003 - page 111
Table 9: Major characteristics of the key anti-dyslipidemic drug classes, 2003 - page 114
Table 10: Breakdown of dyslipidemia management across the different populations in the seven major markets, 2003 - page 115
Table 11: Proportion of drug-treated patients prescribed each type of therapy in the seven major markets, 2003 - page 119
Table 12: Changes in statin prescribing and annual spending in the UK from 2000 to 2003 - page 122
Table 13: Primary and secondary CHD prevention trials with statins in diabetic patients - page 123
Table 14: Comparison of ezetimibe use with other adjunctive drug classes in the US, Germany and the UK, 2003 - page 140
Table 15: Factors influencing the uptake of ezetimibe, 2003 - page 143
Table 16: Comparison of annual cost of Advicor versus generic lovastatin + Niaspan ER, 2003 - page 148
Table 17: ADVOCATE trial results - page 149
Table 18: Number of physicians prescribing rosuvastatin in Germany and the UK, 2003 - page 164
Table 19: Extent to which physicians agree or disagree that rosuvastatin will become the most prescribed statin within the next five years, 2003 - page 167
Table 20: Extent to which physicians agree or disagree that they will be cautious in prescribing Crestor as the safety profile of this drug is unproven, 2003 - page 169
Table 21: Extent to which the physicians agree or disagree that Crestor has HDL cholesterol raising benefits over other statins, which will encourage them to prescribe it, 2003 - page 173
Table 22: Comparison of US drug prices for Lipitor and Crestor, 2003 - page 174
Table 23: Extent to which the physicians agree or disagree that the lack of long-term mortality and morbidity data for Crestor will limit their prescribing of Crestor, 2003 - page 175
Table 24: Sample of physician responses for change in choice of statin for diabetic dyslipidemics, 2003 - page 177
Table 25: Breakdown of statin prescribing by line of therapy in the seven major markets, 2003 - page 182
Table 26: Statin doses available in the seven major markets, 2003 - page 184
Table 27: Breakdown of statin prescribing by daily dose in the seven major markets, 2003 - page 186
Table 28: Proportion of drug-treated dyslipidemia patients prescribed each anti-dyslipidemic drug class as first line therapy in the seven major markets, 2003 - page 215
Table 29: Extent to which physicians agree or disagree that they would only prescribe Crestor at first line in patients requiring a substantial reduction in LDL cholesterol, 2003 - page 219
Table 30: Proportion of drug-treated dyslipidemia patients prescribed each anti-dyslipidemic drug class as second line therapy in the seven major markets, 2003 - page 223
Table 31: Average number of changes a patient undergoes over one year, 2003 - page 227
Table 32: Average number of patient therapy change opportunities over one year in the seven major markets, 2003 - page 227
Table 33: Number and frequency of rhabdomyolysis cases for all the statins in the US from launch to May 2001 - page 230
Table 34: Factors driving versus factors limiting the use of combination therapy in the treatment of dyslipidemia, 2003 - page 235
Table 35: Change in combination therapy over the next three years in the seven major markets, 2003 - page 236
Table 36: Breakdown of combination therapy by dyslipidemia sub-population in the seven major markets, 2003 - page 238
Table 37: Overview of clinical trials assessing statin-fibrate combinations, 2003 - page 242
Table 38: LDL cholesterol reductions with colesevelam alone and in combination - page 251
Table 39: Trial results for ezetimibe in combination with simvastatin - page 256
Table 40: Comparison of efficacy of ezetimibe in combination with simvastatin, atorvastatin, lovastatin and pravastatin - page 258
Table 41: Physician ratings of factors providing incentives for the future prescribing of new therapies as adjuncts to statins in the seven major markets, 2003 - page 266
Table 42: Physician ratings of factors providing disincentives for the future prescribing of new therapies as adjuncts to statins in the seven major markets, 2003 - page 269
Table 43: Proportion of drug-treated dyslipidemia patients in each sub-population failing to reach target cholesterol goals in the seven major markets, 2003 - page 272
Table 44: Average rating of factors influencing the prescribing of anti-dyslipidemic therapy in the seven major markets, 2003 - page 279
Table 45: Comparison of annual cost of therapy in the US of Zetia, WelChol and Niaspan, 2003 - page 290
Table 46: Attempted OTC switching - page 291
Table 47: Issues related to the availability of OTC statins, 2003 - page 294
Table 48: Ranking of factors influencing the prescribing of anti-dyslipidemic therapy - page 305
Table 49: Ranking of factors influencing the prescribing of anti-dyslipidemic therapy - page 323
Table 50: Ranking of factors influencing the prescribing of anti-dyslipidemic therapy - page 339
Table 51: Ranking of factors influencing the prescribing of anti-dyslipidemic therapy - page 352
Table 52: US physician sample breakdown, 2003 - page 376
Table 53: Japan physician sample breakdown, 2003 - page 376
Table 54: France physician sample breakdown, 2003 - page 377
Table 55: Germany physician sample breakdown, 200 - page 377
Table 56: Italy physician sample breakdown, 200 - page 378
Table 57: Spain physician sample breakdown, 2003 - page 378
Table 58: UK physician sample breakdown, 2003 - page 379
Table 59: Risk factors and co-morbidities - page 380
Table 60: Breakdown by type of dyslipidemia - page 380
Table 61: Breakdown of dyslipidemia by disease severity - page 381
Table 62: Management of dyslipidemia by physician type - page 381
Table 63: Breakdown of treatment by lifestyle advice versus drug therapy - page 381
Table 64: Breakdown of drug therapy by anti-dyslipidemic class - page 382
Table 65: Breakdown of statin use by compound - page 382
Table 66: Breakdown of statin use by line of therapy - page 383
Table 67: Breakdown of statin use by daily dose - page 383
Table 68: Current branded versus generic statin prescribing - page 383
Table 69: Future branded versus generic prescribing - page 384
Table 70: Breakdown of fibrate use by compound - page 384
Table 71: Breakdown of first line therapy by anti-dyslipidemic drug class - page 385
Table 72: Breakdown of statin use at first line by compound - page 385
Table 73: Reasons for changes in anti-dyslipidemic therapy - page 386
Table 74: Types of changes in anti-dyslipidemic therapy - page 386
Table 75: Breakdown of second line therapy by anti-dyslipidemic drug class - page 387
Table 76: Proportion of patients receiving combination therapy - page 387
Table 77: Expected change in prescribing of combination therapy over the next three years - page 387
Table 78: Breakdown of combination therapy - page 388
Table 79: Advicor versus prescribing of two separate pills - page 388
Table 80: Patients failing to achieve target cholesterol goals - page 389
Table 81: Rating of factors influencing the prescribing of anti-dyslipidemic therapy - page 389
Table 82: Rating of factors influencing use of new therapies as adjuncts to statins - page 390
Table 83: Order of statin preference for use with ezetimibe - page 390
Table 84: Statement regarding Crestor - page 391
Table 85: Breakdown of patients receiving Crestor after first year on the market - page 391

List of Figures
Figure 1: Scope and coverage of Datamonitor's 2003 dyslipidemia reports - page 4
Figure 2: Key drivers of the dyslipidemia market to 2011 - page 11
Figure 3: Overview of diagnosis rates, treatment rates and prescribing trends in the seven major markets, 2003 - page 13
Figure 4: Diagrammatic overview of the coverage of the dyslipidemia Stakeholder Insight survey, 2003 - page 29
Figure 5: Breakdown of the overall dyslipidemia population in the US by diagnosis, type of dyslipidemia, disease severity and prevalence of risk factors and co-morbidities, 2003 - page 33
Figure 6: Breakdown of drug therapy in the diagnosed dyslipidemia sub-populations in the US, 2003 - page 34
Figure 7: Breakdown of statin therapy by compound, line of therapy, daily dose and use of brands versus generics in the US, 2003 - page 35
Figure 8: Breakdown of first and second line therapy by anti-dyslipidemic drug class in the US, 2003 - page 36
Figure 9: Segmentation of drug-treated overall dyslipidemia population having therapy changed over a one year period in the US, 2003 - page 37
Figure 10: Breakdown of combination therapy by dyslipidemia sub-population in the US, 2003 - page 38
Figure 11: Breakdown of treatment outcomes by dyslipidemia sub-population in the US, 2003 - page 39
Figure 12: Physician awareness and perception of ezetimibe and rosuvastatin in the US in June/July 2003 - page 39
Figure 13: Breakdown of the overall dyslipidemia population in Japan by diagnosis, type of dyslipidemia, disease severity and prevalence of risk factors and co-morbidities, 2003 - page 40
Figure 14: Breakdown of drug therapy in the diagnosed dyslipidemia sub-populations in Japan, 2003 - page 41
Figure 15: Breakdown of statin therapy by compound, line of therapy, daily dose and use of brands versus generics in Japan, 2003 - page 42
Figure 16: Breakdown of first and second line therapy by anti-dyslipidemic drug class in Japan, 2003 - page 43
Figure 17: Segmentation of drug-treated overall dyslipidemia population having therapy changed over a one year period in Japan, 2003 - page 44
Figure 18: Breakdown of combination therapy by dyslipidemia sub-population in Japan, 2003 - page 45
Figure 19: Breakdown of treatment outcomes by dyslipidemia sub-population in Japan, 2003 - page 46
Figure 20: Physician awareness and perception of ezetimibe and rosuvastatin in Japan in June/July 2003 - page 46
Figure 21: Breakdown of the overall dyslipidemia population in France by diagnosis, type of dyslipidemia, disease severity and prevalence of risk factors and co-morbidities, 2003 - page 47
Figure 22: Breakdown of drug therapy in the diagnosed dyslipidemia sub-populations in France, 2003 - page 48
Figure 23: Breakdown of statin therapy by compound, line of therapy, daily dose and use of brands versus generics in France, 2003 - page 49
Figure 24: Breakdown of first and second line therapy by anti-dyslipidemic drug class in France, 2003 - page 50
Figure 25: Segmentation of drug-treated overall dyslipidemia population having therapy changed over a one year period in France, 2003 - page 51
Figure 26: Breakdown of combination therapy by dyslipidemia sub-population in France, 2003 - page 52
Figure 27: Breakdown of treatment outcomes by dyslipidemia sub-population in France, 2003 - page 53
Figure 28: Physician awareness and perception of ezetimibe and rosuvastatin in France in June/July 2003 - page 53
Figure 29: Breakdown of the overall dyslipidemia population in Germany by diagnosis, type of dyslipidemia, disease severity and prevalence of risk factors and co-morbidities, 2003 - page 54
Figure 30: Breakdown of drug therapy in the diagnosed dyslipidemia sub-populations in Germany, 2003 - page 55
Figure 31: Breakdown of statin therapy by compound, line of therapy, daily dose and use of brands versus generics in Germany, 2003 - page 56
Figure 32: Breakdown of first and second line therapy by anti-dyslipidemic drug class in Germany, 2003 - page 57
Figure 33: Segmentation of drug-treated overall dyslipidemia population having therapy changed over a one year period in Germany, 2003 - page 58
Figure 34: Breakdown of combination therapy by dyslipidemia sub-population in Germany, 2003 - page 59
Figure 35: Breakdown of treatment outcomes by dyslipidemia sub-population in Germany, 2003 - page 60
Figure 36: Physician awareness and perception of ezetimibe and rosuvastatin in Germany in June/July 2003 - page 60
Figure 37: Breakdown of the overall dyslipidemia population in Italy by diagnosis, type of dyslipidemia, disease severity and prevalence of risk factors and co-morbidities, 2003 - page 61
Figure 38: Breakdown of drug therapy in the diagnosed dyslipidemia sub-populations in Italy, 2003 - page 62
Figure 39: Breakdown of statin therapy by compound, line of therapy, daily dose and use of brands versus generics in Italy, 2003 - page 63
Figure 40: Breakdown of first and second line therapy by anti-dyslipidemic drug class in Italy, 2003 - page 64
Figure 41: Segmentation of drug-treated overall dyslipidemia population having therapy changed over a one year period in Italy, 2003 - page 65
Figure 42: Breakdown of combination therapy by dyslipidemia sub-population in Italy, 2003 - page 66
Figure 43: Breakdown of treatment outcomes by dyslipidemia sub-population in Italy, 2003 - page 67
Figure 44: Physician awareness and perception of ezetimibe and rosuvastatin in Italy in June/July 2003 - page 67
Figure 45: Breakdown of the overall dyslipidemia population in Spain by diagnosis, type of dyslipidemia, disease severity and prevalence of risk factors and co-morbidities, 2003 - page 68
Figure 46: Breakdown of drug therapy in the diagnosed dyslipidemia sub-populations in Spain, 2003 - page 69
Figure 47: Breakdown of statin therapy by compound, line of therapy, daily dose and use of brands versus generics in Spain, 2003 - page 70
Figure 48: Breakdown of first and second line therapy by anti-dyslipidemic drug class in Spain, 2003 - page 71
Figure 49: Segmentation of drug-treated overall dyslipidemia population having therapy changed over a one year period in Spain, 2003 - page 72
Figure 50: Breakdown of combination therapy by dyslipidemia sub-population in Spain, 2003 - page 73
Figure 51: Breakdown of treatment outcomes by dyslipidemia sub-population in Spain, 2003 - page 74
Figure 52: Physician awareness and perception of ezetimibe and rosuvastatin in Spain in June/July 2003 - page 74
Figure 53: Breakdown of the overall dyslipidemia population in the UK by diagnosis, type of dyslipidemia, disease severity and prevalence of risk factors and co-morbidities, 2003 - page 75
Figure 54: Breakdown of drug therapy in the diagnosed dyslipidemia sub-populations in the UK, 2003 - page 76
Figure 55: Breakdown of statin therapy by compound, line of therapy, daily dose and use of brands versus generics in the UK, 2003 - page 77
Figure 56: Breakdown of first and second line therapy by anti-dyslipidemic drug class in the UK, 2003 - page 78
Figure 57: Segmentation of drug-treated overall dyslipidemia population having therapy changed over a one year period in the UK, 2003 - page 79
Figure 58: Breakdown of combination therapy by dyslipidemia sub-population in the UK, 2003 - page 80
Figure 59: Breakdown of treatment outcomes by dyslipidemia sub-population in the UK, 2003 - page 81
Figure 60: Physician awareness and perception of ezetimibe and rosuvastatin in the UK in June/July 2003 - page 81
Figure 61: Proportion of diagnosed dyslipidemia patients with each type of dyslipidemia in the seven major markets, 2003 - page 91
Figure 62: Proportion of diagnosed hypercholesterolemia patients with familial hypercholesterolemia in the seven major markets, 2003 - page 94
Figure 63: Proportion of diagnosed dyslipidemia patients with low HDL cholesterol in the seven major markets, 2003 - page 96
Figure 64: Breakdown of the diagnosed dyslipidemia population by disease severity in the seven major markets, 2003 - page 101
Figure 65: US age-adjusted prevalence of obese and overweight adults - page 105
Figure 66: Estimated proportion of dyslipidemia patients in the general population diagnosed in the seven major markets, 2003 - page 109
Figure 67: A model of steps in Therapeutic Lifestyle Changes (TLC) from the ATP III guidelines - page 112
Figure 68: Combined seven country breakdown of dyslipidemia management by population, 2003 - page 116
Figure 69: Proportion of dyslipidemia patients in each sub-population prescribed statins across the seven major markets, 2003 - page 121
Figure 70: Proportion of dyslipidemia patients in each sub-population prescribed fibrates across the seven major markets, 2003 - page 126
Figure 71: Proportion of dyslipidemia patients in each sub-population prescribed nicotinic acid derivatives across the seven major markets, 2003 - page 130
Figure 72: Proportion of dyslipidemia patients in each sub-population prescribed bile acid sequestrants across the seven major markets, 2003 - page 133
Figure 73: Proportion of dyslipidemia patients in each sub-population prescribed fish oil derivatives across the seven major markets, 2003 - page 136
Figure 74: Proportion of dyslipidemia patients in each sub-population in the US, Germany and the UK prescribed ezetimibe, 2003 - page 139
Figure 75: Awareness of ezetimibe across the seven major markets, 2003 - page 141
Figure 76: Proportion of overall drug-treated dyslipidemia patients expected to be prescribed ezetimibe by the end of its first year on the market in the seven major markets - page 142
Figure 77: The statin 'rule of six' - page 145
Figure 78: Proportion of dyslipidemia patients in each sub-population prescribed Advicor in the US, 2003 - page 147
Figure 79: Breakdown of statin prescribing by type of statin in overall dyslipidemia patients in the seven major markets, 2003 - page 153
Figure 80: Awareness of rosuvastatin across the seven major markets, June/July 2003 - page 165
Figure 81: Proportion of overall drug-treated dyslipidemia patients expected to be prescribed rosuvastatin by the end of its first year on the market in the seven major markets - page 166
Figure 82: Anticipated prescribing of rosuvastatin in newly diagnosed versus poorly controlled patients by the end of its first year on the market - page 172
Figure 84: Availability of generic statins in the seven major markets, 2003 - page 190
Figure 85: Current and future brand versus generic prescribing of statins in the US - page 191
Figure 86: Current and future brand versus generic prescribing of statins in Japan - page 194
Figure 87: Current and future brand versus generic prescribing of statins in France - page 196
Figure 88: Current and future brand versus generic prescribing of statins in Germany - page 198
Figure 89: Current and future brand versus generic prescribing of statins in Italy - page 199
Figure 90: Current and future brand versus generic prescribing of statins in Spain - page 200
Figure 91: Current and future brand versus generic prescribing of statins in the UK - page 201
Figure 92: Proportion of drug-treated dyslipidemia patients unable to tolerate statin therapy in the seven major markets, 2003 - page 203
Figure 93: Proportion of drug-treated dyslipidemia patients refusing to take statin therapy in the seven major markets, 2003 - page 205
Figure 94: Proportion of dyslipidemia patients on statin therapy that are refractory to statins in the seven major markets, 2003 - page 207
Figure 95: Breakdown of fibrate prescribing by compound in overall dyslipidemia patients in the seven major markets, 2003 - page 209
Figure 96: Proportion of dyslipidemia patients receiving statins at first line prescribed each compound in the seven major markets, 2003 - page 217
Figure 97: Proportion of drug-treated dyslipidemia patients progressing to second line therapy, 2003 - page 221
Figure 98: Comparison of anti-dyslipidemic drug classes at first versus second line in the combined seven markets, 2003 - page 224
Figure 99: Proportion of drug-treated dyslipidemia patients on second line therapy progressing to third line therapy and beyond, 2003 - page 225
Figure 100: Proportion of drug-treated dyslipidemia patients having their therapy changed over a one year period, 2003 - page 226
Figure 101: Reasons for change in anti-dyslipidemic therapy in the seven major markets, 2003 - page 228
Figure 102: Type of changes in anti-dyslipidemic therapy in the seven major markets, 2002 - page 231
Figure 103: Proportion of drug-treated dyslipidemia patients in each sub-population receiving combination therapy in the seven major markets, 2003 - page 234
Figure 104: Proportion of overall drug-treated dyslipidemia patients in each sub-population receiving a statin + fibrate combination in the seven major markets, 2003 - page 239
Figure 105: Proportion of overall drug-treated dyslipidemia patients in each sub-population receiving a statin + nicotinic acid derivative combination in the seven major markets, 2003 - page 245
Figure 106: Breakdown of statin + nicotinic acid derivative combination by Advicor versus two separate pills in the US, 2003 - page 249
Figure 107: Proportion of overall drug-treated dyslipidemia patients in each sub-population receiving a statin + bile acid sequestrant combination in the seven major markets, 2003 - page 250
Figure 108: Proportion of overall drug-treated dyslipidemia patients in each sub-population receiving a statin + fish oil derivative combination in the seven major markets, 2003 - page 253
Figure 109: Proportion of overall drug-treated dyslipidemia patients in each sub-population receiving a statin + ezetimibe combination, 2003 - page 254
Figure 110: Physician rating of the order of statin preference for use in combination with ezetimibe, 2003 - page 259
Figure 111: Proportion of overall drug-treated dyslipidemia patients in each sub-population receiving a non-statin combination, 2003 - page 262
Figure 112: Average ratings across the seven major markets for the incentives versus the disincentives to prescribing, 2003 - page 265
Figure 113: Proportion of drug-treated familial hypercholesterolemia patients failing to reach target cholesterol goals in the seven major markets, 2003 - page 278
Figure 114: Opinion leader ranking of clinical unmet needs in the dyslipidemia market, 2003 - page 281

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Stakeholder Insight: Dyslipidemia - Titration versus Combination Therapy

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