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Impact of the JUPITER Trial on Statin Prescribing for Primary Prevention

Authors

  • Jennifer F. T. Teng,

    1. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
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  • Tara Gomes,

    1. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
    2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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  • Ximena Camacho,

    1. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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  • Scott Grundy,

    1. Center for Human Nutrition and Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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  • David N. Juurlink,

    1. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
    2. Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
    3. The Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
    4. Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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  • Muhammad M. Mamdani

    Corresponding author
    1. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
    2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
    3. Departments of Medicine and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
    4. Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
    5. Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
    6. Department of Medicine, King Saud University, Riyadh, Saudi Arabia
    • Address for correspondence: Muhammad Mamdani, Associate Professor, Faculty of Medicine, Health Policy, Management and Evaluation and Pharmacy, University of Toronto, Applied Health Research Centre, St. Michael's Hospital Toronto, Applied Health Research Centre, 30 Bond Street, Toronto, ON, Canada M5B 1W8; e-mail: mamdanim@smh.ca.

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  • This study was funded by the Ontario Drug Policy Research Network. The Ontario Drug Policy Research Network/Ministry of Health and Long-Term Care had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.
  • Dr. Mamdani has served on advisory boards for Hoffmann–La Roche, GlaxoSmithKline, Pfizer, Novartis, Eli Lilly and Company, Novo Nordisk, AstraZeneca, and Bristol-Myers Squibb. All other authors have no relationships relevant to the contents of this article to disclose.
  • The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.

Abstract

Study Objective

As the Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial identified a new population of individuals with cholesterol levels below traditional treatment thresholds but with elevated high-sensitivity C-reactive protein (hs-CRP) levels who may benefit from primary prevention with statin therapy, we sought to evaluate the impact of this trial on the incident prescription rates of rosuvastatin alone as well as all statins in a primary prevention population.

Design

Population-based, cross-sectional time-series analysis.

Data Source

Administrative health care databases in Ontario, Canada.

Patients

A total of 299,809 incident statin users 66 years or older were identified during the study period, from January 1, 2003, to March 31, 2011, who were prescribed statin therapy for primary prevention.

Measurements and Main Results

We evaluated the incident rate of rosuvastatin and all statin use during each quarter of the study period. Overall, no significant trends in all incident statin use were observed (p=0.99). Furthermore, no significant differences were observed in incident rates of rosuvastatin (p=0.21) or all statin (p=0.41) use after the publication of the JUPITER trial. Despite the lack of impact of the JUPITER trial on rosuvastatin or all statin utilization, the relative market share of rosuvastatin increased from 9% to 65% over the study period.

Conclusion

The publication of the JUPITER trial did not significantly affect trends in overall statin and rosuvastatin prescribing patterns for primary prevention in this study. Increases in the relative market share of rosuvastatin may be attributed to the impact of the pharmaceutical industry on prescribing patterns. Our results highlight the need to further improve the integration of evidence-based prescribing into cost-effective clinical practice.

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