In the study where it helped patients lose weight, the drug also raised good cholesterol, or high-density lipoprotein (HDL), by 23%, almost as much as Niaspan, the sustained-release niacin drug made by Kos Pharmaceuticals (nasdaq: KOSP - news - people ) that is the main currently available treatment for raising HDL. Rimonabont also cut triglycerides, another risk factor for heart disease, by 16%.
The case for raising HDL rests not on clinical trials but mostly on studies showing circumstantial connections.
For Fogelman, who has been working HDL drugs for years and has several more in the Bruin pipeline, the promise is huge.
For niacin, used to raise HDL, and for fish oil pills its 10, 000.
Researchers who hope for a successful, HDL-raising drug now say they worry pharmaceutical companies may not revisit the approach.
Although niacin, a natural vitamin, has been used for decades to raise HDL, a clinical benefit has never been demonstrated.
FORBES: HPS2-THRIVE: No Benefit, Signal Of Harm For Niacin Therapy
He points out that patients received the drug, a mutation of HDL cholesterol, for only five weeks.
Alan Tall of Columbia University says the results were "interesting and exciting, " and, moreover, were a "proof of concept" for the idea that raising HDL cholesterol can move plaque out of the arteries.
Researchers speculating about what went wrong thought perhaps torcetrapib made HDL that didn't work, or that HDL itself (short for high-density lipoprotein, and often called "good cholesterol") was less powerful than they thought.
For some experimental medicines, like HDL-raising drugs being developed by Merck and Eli Lilly that are known as CETP inhibitors, this result only affects how much value investors assign to those research programs.
FORBES: Why Merck's Niacin Failure Will Scare Drug Researchers
At a major cardiology meeting last November and this March, Merck distributed promotional materials emphasizing the importance of HDL to prime the market for the new drug.
If that doesn't work--and it won't for many people--try an ancient HDL-raiser, the B vitamin niacin, if you can live with its annoying side effect (hot flashes).
By using olive oil, you can decrease your total-cholesterol levels while maintaining your HDL levels, thus decreasing your risk for heart disease.
HPS2-THRIVE adds to the string of failures associated with trials of HDL-related therapies, although some hope remains for CETP inhibitors, despite the failure of two large clinical trials.
FORBES: HPS2-THRIVE: No Benefit, Signal Of Harm For Niacin Therapy
Another Zetia benefit: In studies, some patients not only saw "bad" LDL cholesterol decrease, they also saw a slight increase in "good" HDL cholesterol, which is thought to be better for health.
And researchers and Wall Street analysts have had another reason for viewing it as an also-ran: It is only half as effective as torcetrapib, boosting HDL by only 30%.
It represented a fast approach to entering the HDL market and an example of getting researchers in different disease disciplines to work together, a triumph for Kim as he tried to revitalize Merck's research efforts.
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