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Niacin use substantial, growing in US and Canada

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Prescription niacin sales increased 191.2% from 2002 to 2009, to reach 696,000 prescriptions per month in the United States in December 2009, according to new data in JAMA Internal Medicine.

In Canada, niacin use increased sevenfold from 2005 to 2009, when Niaspan (Abbott Laboratories) was introduced, to reach 13,876 prescriptions per month in 2009.

“The AIM-HIGH and HPS2-THRIVE studies were conducted owing to uncertainty of the benefit of niacin in reducing clinical outcomes in the contemporary statin era. With the recent attention on two negative large clinical trials with niacin, it is an opportune time to reflect on how niacin is currently being used in practice and whether evidence justifies this level of use,” Cynthia A. Jackevicius, BScPhm, PharmD, MSc, and colleagues wrote in a research letter.

The researchers conducted a population-level, observational, cohort study of recent trends in niacin and statin use and expenditures. US and Canadian pharmacy audits were used to measure numbers of dispensed prescriptions and expenditures from 2002 to 2009.

During this period, statin use in the United States increased 71.9% and use in Canada increased 163.1% (P<.001 for both).

Niaspan comprised most prescriptions in both countries. In 2009, 81.6% of US niacin prescriptions were for Niaspan; Advicor (niacin plus lovastatin, Abbvie Inc.) and Simcor (niacin plus simvastatin, Abbvie Inc.) accounted for 18.4%. In 2009, 85.5% of Canadian niacin prescriptions were for Niaspan; Advicor accounted for only 1.7% and Simcor was unavailable.

During the 8-year period, niacin prescriptions increased in both countries. The rate of increase in use was higher in Canada (P<.001), but the rate of increase relative to baseline use was higher in the United States (P<.001). In 2009, niacin prescriptions in the United States were approximately sixfold higher per 100,000 population (P<.001).

In 2009, prescription niacin expenditures in the United States totaled $881,239,000 ($732,194,000 for Niaspan) and in Canada totaled $12,927,523 ($12,377,867 for Niaspan). US niacin expenditures in 2009 were about sevenfold higher per 100,000 population.

“Over the last 5 years of our study, a total of $3.4 billion was spent on prescription niacin in the United States,” the researchers wrote.

These data show that sales for prescription niacin are “substantial and growing, even in the absence of contemporary supportive trial evidence,” according to the researchers. “The discordance between sales and evidence should be a focus of professional dialogue about the role of this medication in the medical armamentarium.”

For more information:

Jackevicius CA. JAMA Intern Med. 2013;doi:10.1001/jamainternmed.2013.6489.

Disclosure: One researcher is the recipient of a research grant, through Yale University, from Medtronic and chairs a cardiac scientific advisory board for UnitedHealth.