As the long-running battle for dominance in the highly-lucrative stent market continues its twists and turns, Johnson & Johnson will be cheered on news that its Cypher stent has come out on top in a meta-analysis published in this week’s issue of the Journal of the American Medical Association (2005;294:819-825), knocking Boston Scientific’s rival offering Taxus into touch.

The research evaluated data from six trials involving 3,670 patients who received either Cypher (a sirolimus-eluting stent) or Taxus (paclitaxel-eluting stent) for coronary artery disease. Findings showed patients receiving the Cypher stent had a significantly reduced risk of restenosis, or the re-narrowing of the blood vessel, than those given the Taxus stent (9.3% versus 13.1%). In addition, revascularisation, the primary outcome, was less frequently performed in patients who were treated with Cypher (5.1%) versus Taxus (7.8%), but event rates in terms of death, death or heart attack, or stent thrombosis, were similar across the two groups.

In addition, two further studies, published this week in the New England Journal of Medicine, found that J&J’s offering was also associated with a reduced rate of restenosis and subsequently major cardiac events. However, Boston Scientific will likely point to J&J’s own head-to-head study, REALITY, which demonstrated equivalent rates of restenosis between both Cyper and Taxus receivers [[05/03/04d]].

One of the reasons for the enormous commercial success of the coated stents currently on the market - Johnson & Johnson's Cypher and Boston Scientific's Taxus - was their immense improvement over earlier bare metal stents in blocking restenosis. The process, in which the lining of the blood vessel opened using a stent grows through the scaffold and causes it to re-block, was a serious problem with the early generation of stents. By solving the problem, sales of Cypher and Taxus were able to quickly ramp up and reached about $3 billion last year.