Abstract
To assess the type and degree of innovation of the cardiovascular drugs centrally approved in the European Union between 1995 and 2002. Sources of information were the European Public Assessment Reports and the Summaries of Product Characteristics published by the European Medicines Evaluation Agency. The Agency approved 11 active substances belonging to 5 therapeutic classes: anti-hypertensives, anti-arrhythmics, anti-platelets, anti-coagulants and fibrinolytics. Analysis of the documentation on which the marketing authorisation was based shows few elements of innovation. Moreover, the new drugs usually cost more than similar drugs already available. Cardiovascular drugs approved in Europe in the last few years have contributed little to progress in this area. These approvals provide no real advantage to patients and lay an economic burden on society.
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Garattini S, Bertele' V (2002) Efficacy, safety, and cost of new anticancer drugs. BMJ 325:269–271
Garattini S, Bertele' V (2003) Efficacy, safety, and cost of new drugs acting on central nervous system. Eur J Clin Pharmacol 59:79–84
Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, Godwin J, Qizilbash N, Taylor JO, Hennekens CH (1990) Blood pressure, stroke, and coronary heart disease. Part 2. Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335:827–838
Blood Pressure Lowering Treatment Trialists' Collaboration (2000) Effects of ACE inhibitors, calcium antagonists, and other blood pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet 355:1955–1964
Torp-Pedersen C, Møller M, Bloch-Thomsen PE, Køber L, Sandøe E, Egstrup K, Agner E, Carlsen J, Videbaek J, Marchant B, Camm AJ, for The Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group (1999) Dofetilide in patients with congestive heart failure and left ventricular dysfunction. N Engl J Med 341:857–865
McClellan KJ, Markham A (1999) Dofetilide: a review of its use in atrial fibrillation and atrial flutter. Drugs 58:1043–1059
CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339
Born GVR, Collins R (1997) Aspirin versus clopidogrel: the wrong question? Lancet 349:806–807
Topol EJ, Byzova TV, Plow EF (1999) Platelet GPIIb-IIIa blockers. Lancet 353:227–231
PURSUIT investigators (1998) Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes: platelet glycoprotein IIb/IIIa in unstable angina—receptor suppression using integrilin therapy. N Engl J Med 339:436–443
Greinacher A, Eichler P, Lubenow N, Kwasny H, Luz M (2000) Heparin-induced thrombocytopenia with thromboembolic complications: meta-analysis of 2 prospective trials to assess the value of parenteral treatment with lepirudin and its therapeutic aPTT range. Blood 96:846–851
Eriksson BI, Wille-Jørgensen P, Kälebo P, Mouret P, Rosencher N, Bösch P, Baur M, Ekman S, Bach D, Lindbratt S, Close P (1997) A comparison of recombinant hirudin with a low-molecular-weight heparin to prevent thromboembolic complications after total hip replacement. N Engl J Med 337:1329–1335
Eriksson BE, Bauer KA, Lassen MR, Turpie AGG for the Steering Committee of the Pentasaccharide in Hip-Fracture Surgery Study (2001) Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N Engl J Med 345:1298–1304
Bauer KA, Eriksson BE, Lassen MR, Turpie AGG for the Steering Committee of the Pentasaccharide in Major Knee Surgery Study. (2001) Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery. N Engl J Med 345:1305–1310
Lassen MR (2000) The EPHESUS Study: comparison of the first synthetic factor Xa inhibitor with low molecular weight heparin (LMWH) in the prevention of venous thromboembolism (VTE) after elective hip replacement surgery. Blood 96:490a
Turpie G (2000) The PENTATHLON 2000 Study: comparison of the first synthetic factor Xa inhibitor with low molecular weight heparin in the prevention of venous thromboembolism (VTE) after elective hip replacement surgery. Blood 96:491a
Diuguid DL (2001) Choosing a parenteral anticoagulant agent. N Engl J Med 345:1340–1342
International Joint Efficacy Comparison of Thrombolytics (1995) Randomised, double-blind comparison of reteplase double-bolus administration with streptokinase in acute myocardial infarction (INJECT): trial to investigate equivalence. Lancet 346:329–333
The Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO-III) investigators (1997) A comparison of reteplase with alteplase for acute myocardial infarction. N Engl J Med 337:1118–1123
Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) investigators (1999) Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet 354:716–722
Bertele' V, Torri V, Garattini S (1999) Inconclusive messages from equivalence trials in thrombolysis. Heart 81:675–676
Yusuf S (2002) Two decades of progress in preventing vascular disease. Lancet 360:2–3
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We are indebted to Mrs Judy Baggott for helpful editorial assistance.
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S.G. and V.B., respectively, act as member and expert of the CPMP. The views presented in this paper are those of the authors and should not be understood or quoted as being made on behalf of the EMEA and/or its scientific committees.
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Garattini, S., Bertele', V. Efficacy, safety and cost of new cardiovascular drugs: a survey. Eur J Clin Pharmacol 59, 701–706 (2003). https://doi.org/10.1007/s00228-003-0634-y
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DOI: https://doi.org/10.1007/s00228-003-0634-y