Will JUPITER Change Pharma's View of the World?

On Monday, the U.S. Food and Drug Administration approved Astrazeneca's  cholesterol-lowering medication Crestor (rosuvastatin) for some patients who are at increased risk of heart disease but have not been diagnosed with it. The decision was based on results from the JUPITER study, which compared over 15,000 patients - half of whom received Crestor for two years and half received placebo.  
The study looked at men over 50 and women over 60 who had an elevated amount of high sensitivity C-reactive protein (a known risk factor for inflammation and atherosclerosis) and at least one additional factor such as smoking, high blood pressure, a family history of premature heart disease, or low amounts of HDL ("good") cholesterol.

Crestor is a statin in the same class as drugs made by Pfizer, Merck and others, but the first to be licensed for such widescale "primary" (ie  before disease onset) preventative use. We can expect the sales of statins generally to increase on the back of this data, and it will be a big boost to AZ in particular.

Some will be critical of the trend to mass medication of the apparently healthy, but if there is solid evidence of benefit then I don't see the objection.  The challenge will be "adherence", the industry term for persuading people to keep taking the medication long-term. When the patient feels healthy and all they see is the drug cost, there is a temptation to stop medication, or to skip doses to make it last longer. 

This is where other patient support and testing services come in.  On a wider level, the move to large-scale primary prevention may mark another step in the integration of the drug industry with life-long healthcare services - what I have previously called "Healthcare as Total Service", or HaTS. It's not always possible (eg cancer) but, as a commercial model, keeping people healthy makes a whole lot more sense than only treating them when they get sick.