JUPITER: not again

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Last Thursday’s New England Journal of Medicine gave us yet another round of data from the JUPITER trial.  For those of you who might not be familiar with JUPITER, it’s a large study looking at the effects of rosuvastatin (aka Crestor) on mostly overweight people with an abnormality of a particular lab value known as the CRP.  The first go-round of the JUPITER trial was published in an earlier volume of the NEJM, heralding the wondrous effects of rosuvastatin on lowering the risk of cardiovascular events.  In the latest issue of NEJM, we are asked to marvel at the medication’s effects on decreasing the risk of venous thromboembolism (blood clots within the veins).

Except that the effects aren’t that marvellous, unless you’re a statistician that froths at the mouth when you can tease a teeny tiny bit of significance out of a heapload of data.  The article’s summaries tout a relative reduction in the risk of venous thromboembolism of 43%.  But if you look closely at the data, the absolute risk reduction went from 60 individuals out of 8,901 to 34 out of 8,901 over the course of 1.9 years.  In real-world terms, that means that for one individual to see this particular benefit, about 340 people would need to take rosuvastatin every single day for almost two years.  Crestor (rosuvastatin isn’t available generically) costs around $120 per month, retail, which means almost one million dollars in medication costs to prevent one clot.  One.  Million.  Dollars.  One clot.

In fairness, most reasonably sane physicians would never prescribe rosuvastatin only to prevent blood clots.  In an April 15th Internal Medicine News article Dr. Glynn, one of the study’s authors, stated that this risk reduction, combined with previously reported risk reductions in cardiovascular events, would mean that one adverse event could be prevented for every 18 people treated over five years.  By my calculations, that’s a total medication cost of almost $130,000.  Dr. Ridker, another one of the article’s authors, was quoted in the same article  as saying “The JUPITER trial turned out even better than anyone on the steering committee could have hoped for. It’s a spectacular win for patients. This is a great way to save lives and do it in a cost-effective manner.”

This is probably true if the one “event” prevented was a massive MI requiring a coronary artery bypass surgery followed by a significant ICU stay, or a major stroke resulting in lifelong impairment.  But can we please keep in mind that over 75% of the patients in this study were overweight?  For $120 per month we could get them a gym membership, enrollment in a weight loss service, and maybe even a few sessions with a personal trainer.  I can almost guarantee you that more than one person in eighteen would see a substantial benefit, not only in cardiovascular event reduction, but also in well-being, decreased risk of diabetes, and overall health.   We in the medical profession need to spend less time examining the effects of medications still under patent via studies funded by the medication’s makers and more time addressing how we get the general population more healthy overall.