A Boston Cientific e a Johsson & Johnson estão travando há mais de um ano uma guerra para mostrar que tem o melhor stent com medicamento no mercado. Ambas patrocinaram trabalhos que as favorecem, cada uma a seu tempo. Agora, duas apresentações no World Congress of Cardiology recém terminado em Barcelona, Espanha, reduziram as expectativas desse tipo de stent em relação ao tradicional. O melhor texto explicando a confusão é de hoje do The New York Times. Mas, voltaremos ao tema porque essa é uma questão central na organização da assistência ao infartado no Brasil. Interessante, que o estudo citado, o suíco Basket, não nega o uso desses stents, somente limita a sua indicação.
A grosso modo há um aumento considerável no gasto do atendimento ao infartado no mundo todo porque progressivamente os tratamentos mais adequados vão sendo superados por outros mais caros. Muitas aspas em adequados e superados.
Stent Makers Hurt by Reports About Safety By BARNABY J. FEDER Published: September 8, 2006 (copyright NYT) Shareholder qualms about growth prospects for the $5 billion coronary stunt business yesterday shook the stocks of Boston Scientific and Johnson & Johnson, the two leading stent makers. Shares of Boston Scientific fell 3.3 percent, or 57 cents, to $16.70. The stock of Johnson & Johnson, whose overall business is less dependent on stents, fell 46 ceNts, to $63.46. The declines came after a stream of reports about stent safety from a European medical meeting. Those included the disclosure yesterday that Boston Scientific had quietly told federal regulators this summer that new analysis of the company’s accumulating safety data found that patients using its best-selling Taxus stent had a slightly greater but statistically clear risk of developing potentially deadly blood clots compared with older stent designs. Among the earlier reports at the meeting was a Swiss study suggesting that in some patient groups the Cypher stent of Johnson & Johnson posed even higher long-term clotting risks than Taxus. Stents are metal sleeves inserted in arteries to keep them propped open after medical procedures to clear blockages. Although some are used during heart bypass surgery, most coronary stents are inserted as a follow-up to angioplasty, a less invasive procedure in which the blockage is cleared from inside the artery by inflating a balloon. The balloon and stent are delivered to the heart area via a long catheter inserted into a blood vessel in the patient’s thigh. Stents were first used in the 1990’s. The original designs were bare metal devices. Cypher, introduced in the United States in 2003, and Taxus, which was cleared for sale in 2004, are drug-coated devices. The coatings are meant to combat the tendency of arteries to form new blockages, a process called restenosis. Although the drug-coated devices cost more than $2,000 on average, compared with $800 or so for bare metal devices, they rapidly supplanted the older designs in the United States and now account for 85 percent to 90 percent of the market. Analysts said that the stock market reaction reflected fears that growth in the stent market would slow and that more doctors would prescribe the less profitable bare metal products. Word of Boston Scientific’s report to regulators, whom it met with on Aug. 1, and the news that Food and Drug Administration officials then asked Johnson & Johnson for more data on its Cypher stent, was reported yesterday in The Wall Street Journal.