Selected research from leading health care experts whose findings have a direct bearing on public policies effecting medical progress. Research is chosen based on its quality and relevance by the Medical Progress Today editorial staff.

Selected Research

Sirolimus-Eluting Stents vs Paclitaxel-Eluting Stents in Patients With Coronary Artery Disease: Meta-analysis of Randomized Trials
Adnan Kastrati, MD, Alban Dibra, MD, The Journal of the American Medical Association, 8-17-05

Better information about health outcomes should help drive funding toward better treatments—rewarding innovative companies in the process. For instance, this study uses a meta-analysis of several published studies to compare two drug-eluting stents made by competing manufacturers (Johnson & Johnson and Boston Scientific). (A New York Times article discussing this study is also available here.)

Although the study didn't find a mortality advantage for either stent, it did show that the J&J sent was less likely to cause side-effects that could require additional surgery. Physicians and patients, therefore, will probably gravitate towards J&J's stent.

Technical proficiency, however, doesn't win market share by itself. The Times article also points out that "[Johnson & Johnson continues] to struggle with manufacturing constraints that limit the treatment's availability," and might not be able to translate a better stent into market supremacy.

Placement of sirolimus-eluting stents [made by Johnson & Johnson] or paclitaxel-eluting stents [made by Boston Scientific] has emerged as the predominant percutaneous treatment strategy in patients with coronary artery disease (CAD). Whether there are any differences in efficacy and safety between these 2 drug-eluting stents is unclear.

Six trials, including 3669 patients, met the selection criteria. No significant heterogeneity was found across trials. Target lesion revascularization, the primary outcome of interest, was less frequently performed in patients who were treated with the sirolimus-eluting stent (5.1%) vs the paclitaxel-eluting stent (7.8%)…Similarly, angiographic restenosis was less frequently observed among patients assigned to the sirolimus-eluting stent (9.3%) vs the paclitaxel-eluting stent…Event rates for sirolimus-eluting vs paclitaxel-eluting stents were 0.9% and 1.1%, respectively, for stent thrombosis…1.4% and 1.6%, respectively, for death…and 4.9% and 5.8%, respectively, for the composite of death or MI…

[The researchers concluded that] patients receiving sirolimus-eluting stents had a significantly lower risk of restenosis and target vessel revascularization compared with those receiving paclitaxel-eluting stents. Rates of death, death or MI, and stent thrombosis were similar.

Health-care competition, in other words, pays dividends as companies duel to bring the best products to market.

Project FDA.
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