HPS2-THRIVE analysis: Adding niacin with laropiprant to statin reduced survival, increased costs
Quality of life-adjusted survival was reduced and hospital costs rose due to the addition of extended-release niacin with laropiprant to statin-based therapy, according to a new analysis of the HPS2-THRIVE study.
Researchers analyzed data from 25,673 patients aged 50 to 80 years with a history of MI, cerebrovascular disease, peripheral artery disease or diabetes with any evidence of symptomatic coronary disease from 245 hospitals in China, Denmark, Finland, Norway, Sweden and the United Kingdom.
The cohort was stratified according to those who received extended-release niacin 2 g with laropiprant 40 mg daily vs. matching placebo. All patients were assigned a statin-based LDL-lowering therapy.
Researchers found patients assigned niacin–laropiprant saw marginally but not statistically significant lower survival (0.012 fewer years), as well as fewer quality-adjusted life-years (0.023 fewer years in U.K. EQ-5D-3L questionnaire scores; 0.02 fewer years with U.S. EQ-5D-3L scores).
According to the researchers, stroke, HF, musculoskeletal and gastrointestinal events, and infections were associated with reductions in quality-adjusted life-years.
Patients assigned niacin with laropiprant also experienced higher hospital costs compared with the placebo group (U.K. £101; U.S. $145), with serious vascular and nonvascular events being associated with increased costs.
“It is possible that laropiprant contributed to the observed hazards of niacin–laropiprant; however, the consistency of the side-effect profile with previous studies of niacin alone suggests that the adverse effects observed in HPS2-THRIVE are likely mainly because of niacin,” the researchers wrote. “The cost of the niacin-based intervention itself ... represents a further burden to the health care provider and the patient.” – by James Clark
Disclosure: HPS2-THRIVE was partly sponsored by Merck. The researchers report no relevant financial disclosures.