Drug-coated stents may be losing favor

After a three-year run in which drug-coated stents grew into one of the most profitable, fastest-selling medical devices in history, doctors now appear to be using fewer of them -- a change that could hurt local life-science giant Boston Scientific Corp.

As more evidence emerges that suggests drug-coated stents have caused higher rates of blood clots than the older generation of bare-metal stents, doctors at many hospitals have recently begun shifting toward the older, bare-metal stents they replaced, according to figures provided yesterday to the Globe by Goodroe Healthcare Solutions LLC.

The slide is modest, but even tiny shifts in the stent market can hurt revenues.

Each percentage point of sales is worth several million dollars per quarter, and Boston Scientific, based in Natick, has built itself into one of the state's largest companies on the strength of more than $2 billion in annual revenue generated by stents alone.

In the third quarter, drug-eluting stents represented 86 percent of all stents used in heart-repair procedures, down from 88 percent in the previous quarter, according to Goodroe, which closely monitors preferences of doctors at dozens of hospitals across the country.

The new figures measured stent use in about 35,000 heart procedures at 78 hospitals.

``It's the first time that we're aware of that there's been even a 2 percent decrease" in the share of drug-coated stents, said Joane Goodroe , the company's president.

The overall number of heart procedures is holding steady, she said, so a shift from drug-coated stents is likely to presage an overall decrease in sales.

The tiny wire mesh tubes are one of the most widely implanted medical devices in the world.

Doctors use them to keep coronary arteries open after they have been cleared of blockages. On newer stents, a drug coating slowly leaks out to prevent the artery from narrowing as it heals.

A Boston Scientific spokesman declined to comment on the company's recent sales, saying the figures will be released when earnings are announced today.

In late September, however, the company warned Wall Street that its stent sales for the third quarter of 2006 would be $550 million to $580 million , down from $600 million the previous year.

Yesterday , rival Johnson & Johnson said it had seen third-quarter US sales of its competing Cypher stent drop to $327 million, down 6 percent from the same quarter last year. International sales dropped 3 percent to $300 million.

Unlike its rival, which is a highly diversified healthcare company, Boston Scientific counts on drug-eluting stents for a large proportion of its total sales, and needs the continued income to pay down the debt it incurred buying Guidant Corp. for $27 billion in April.

At more than $2,000 each, drug-coated stents are far more expensive and profitable than the $800 bare-metal versions. Boston Scientific and Johnson & Johnson are the only two companies approved to sell them in the United States.

Recently, drug-coated stents have been shadowed by a flurry of news about their long-term side effects.

Doctors have found that a small number of patients develop blood clots inside drug-coated stents long after they are implanted. Such late-forming clots, which are frequently fatal, almost never appear in bare-metal stents.

Since the clotting issue has emerged as a high-profile topic at cardiology conferences this year, financial analysts have been watching carefully to see whether doctors begin to lean away from the newer generation, and toward the older bare-metal stents.

Stephen Heuser can be reached at sheuser@globe.com.