Evidence regarding the clinical benefit of fibrate therapy remains mixed.  Although some older trials suggested a reduction cardiovascular events compared to placebo, more recent studies (e.g. ACCORD, FIELD) have failed to show any added benefit over statin therapy.  The aim of this study was to examine trends in the use of fibrates in the US and Canada over the last decade, using IMS Health data from the United States and Canada of patients prescribed fibrates between January 2002 and December 2009.

In the US, fibrate prescriptions dispensed increased from 336 prescriptions/100 000 population in January 2002 to 730 prescriptions/100 000 population in December 2009, an increase of 117.1% (95% confidence interval [CI], 116.0%- 117.9%).  However in Canada, fibrate prescriptions increased from 402 prescriptions/ 100 000 population in January 2002 to 474 prescriptions/100 000 population in December 2009, an increase of 18.1% (95% CI, 17.9%-18.3%) (P<.001).  The annual ratio of generic to brand-name fenofibrate use in the United States ranged from 0:1 to 0.09:1 between 2002 and 2008, while the ratio in Canada steadily increased from 0.51:1 to 1.89:1 between 2005 and 2008. Furthermore, crude fenofibrate expenditures increased from $11 535/100 000 population/month in the US in 2002 to $44 975/100 000 population/month in 2009, while the rates in Canada declined from $17 695/100 000 population/ month in 2002 to $16 112/100 000 population/month in 2009.

Conclusion:

Despite the emergence of evidence questioning their efficacy in the statin era, the use of fibrates (especially fenofibrate) has increased in the US over the last decade.  This study therefore highlights the gap that exists between contemporary cardiovascular prescribing and available clinical evidence.

• Jackevicius CS, Tu JV, Ross JS et al.  Use of Fibrates in the United States and Canada.  JAMA. 2011;305(12):1217-1224