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Tamargo J, Rosano G. Low quality of some generic cardiovascular medicinal products represents a matter for growing concern. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 6:176-187. [PMID: 31501855 DOI: 10.1093/ehjcvp/pvz037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/15/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022]
Abstract
AIMS Generic medicinal products (GMPs) are low-priced copies of off-patent medicines that reduce healthcare costs and broaden access to healthcare. Thus, healthcare authorities, professionals, and providers recommend their use. In recent years, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) approved hundreds of GMPs based on specific bioequivalent trials. The question is whether the brand name drugs and GMPs or the different GMPs similar in purity, efficacy, and safety. METHODS AND RESULTS We have reviewed the progressive increasing recalls and warning letters of cardiovascular GMPs issued recently by the FDA/EMA. Both Agencies found numerous irregularities in the purity, safety, effectiveness, and current good manufacturing practices in some GMPs widely used in cardiovascular therapy. This evidence and the recent identification of nitrosamine impurities classified as probable human carcinogens in several angiotensin receptor blockers confirm that the presence of low-quality/substandard GMPs represents a serious public health problem with significant impact on national clinical and economic burden. CONCLUSION A global strategy that unifies the efforts of all the stakeholders, including drug manufacturers, healthcare providers, governments, health professionals, patients, and judicial systems are needed to protect the drug chain supply and ensure that only high-quality GMPs are available for use.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, Madrid 28040, Spain
| | - Giuseppe Rosano
- Division of Cardiovascular and Cell Sciences Institute, St. George's Hospital, Blackshaw Rd, London, UK.,IRCCS San Raffaele Pisana, Rome, Italy
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Kang A, Thompson A, Rau J, Pollock A. Effects of clinical decision support and pharmacist prescribing authority on a therapeutic interchange program. Am J Health Syst Pharm 2019; 75:S77-S81. [PMID: 30139727 DOI: 10.2146/ajhp170465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of an evaluation of therapeutic interchange (TI) program outcomes with use of prescriber alerts alone or in combination with pharmacist prescribing are reported. METHODS A retrospective single-center study was conducted to compare TI outcomes before incorporation of prescriber alerts encouraging formulary agent use into the electronic medical record (period 1), after alert implementation (period 2), and after implementation and expansion of TI protocols including pharmacist prescribing authority (period 3). The evaluation focused on TI orders for 3 drug classes: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (HMG-CoA RIs). The primary outcome was formulary medication utilization. RESULTS In total, 2,881, 2,700, and 3,088 prescriptions for medications in the ACEI, ARB, or HMG-CoA RI class were ordered during periods 1, 2, and 3, respectively. Overall formulary adherence improved from 78.3% in period 1 to 97.6% in period 2 and 99.2% in period 3 (p < 0.001 for both comparisons with period 1). The percentages of inappropriate dosing conversions were 51.6%, 37.2%, and 2.4% in periods 1, 2, and 3, respectively; the corresponding percentages of inappropriate discharge medications were 64.5%, 16.3%, and 2.4%. CONCLUSION Percentages of formulary medications in 3 medication classes, considered separately and together, increased with the implementation of TI alerts for prescribers and the addition of TI-related pharmacist prescribing authority. Over the same study periods, percentages of inappropriate dosing conversions and inappropriate discharge medications decreased.
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Affiliation(s)
- Amy Kang
- Department of Pharmacy Practice, Chapman University, Irvine, CA
| | - Ashley Thompson
- Department of Pharmacy Practice, Chapman University, Irvine, CA
| | - Johnny Rau
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, and Department of Pharmaceutical Services, UCSF Medical Center San Francisco, CA
| | - Allison Pollock
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, CA, and Department of Pharmaceutical Services, UCSF Medical Center, San Francisco, CA
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Hu S, Zuo H, Qi J, Hu Y, Yu B. Analysis of Effect of Schisandra in the Treatment of Myocardial Infarction Based on Three-Mode Gene Ontology Network. Front Pharmacol 2019; 10:232. [PMID: 30949047 PMCID: PMC6435518 DOI: 10.3389/fphar.2019.00232] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Abstract
Schisandra chinensis is a commonly used traditional Chinese medicine, which has been widely used in the treatment of acute myocardial infarction in China. However, it has been difficult to systematically clarify the major pharmacological effect of Schisandra, due to its multi-component complex mechanism. In order to solve this problem, a comprehensive network analysis method was established based-on “component–gene ontology–effect” interactions. Through the network analysis, reduction of cardiac preload and myocardial contractility was shown to be the major effect of Schisandra components, which was further experimentally validated. In addition, the expression of NCOR2 and NFAT in myocyte were experimentally confirmed to be associated with Schisandra in the treatment of AMI, which may be responsible for the preservation effect of myocardial contractility. In conclusion, the three-mode gene ontology network can be an effective network analysis workflow to evaluate the pharmacological effects of a multi-drug complex system.
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Affiliation(s)
- Siyao Hu
- Jiangsu Key Laboratory of Traditional Medicine and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Huali Zuo
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau
| | - Jin Qi
- Jiangsu Key Laboratory of Traditional Medicine and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Yuanjia Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau
| | - Boyang Yu
- Jiangsu Key Laboratory of Traditional Medicine and Translational Research, China Pharmaceutical University, Nanjing, China
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Engelkes M, van Blijderveen JC, Overbeek JA, Kuiper J, Herings RCM, Sturkenboom MCJM, de Jongste JC, Verhamme KMC, Janssens HM. Brand and generic use of inhalation medication and frequency of switching in children and adults: A population-based cohort study. J Asthma 2017; 55:1086-1094. [PMID: 29185812 DOI: 10.1080/02770903.2017.1396468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The expiration of patents of brand inhalation medications and the ongoing pressure on healthcare budgets resulted in a growing market for generics. AIM To study the use of brand and generic inhalation medication and the frequency of switching between brand and generic and between devices. In addition, we investigated whether switching affected adherence. METHODS From dispensing data from the Dutch PHARMO Database Network a cohort aged ≥ 5 years, using ≥ 1 year of inhalation medication between 2003 and 2012 was selected. Switching was defined as changing from brand to generic or vice versa. In addition, we studied change in aerosol delivery device type (e.g., DPI, pMDI, and nebulizers). Adherence was calculated using the medication possession ratio (MPR). RESULTS The total cohort comprised 70,053 patients with 1,604,488 dispensations. Per calendar year, 5% switched between brand and generic inhalation medication and 5% switched between devices. Median MPRs over the first 12 months ranged between 33 and 55%. Median MPR over the total period was lower after switch from brand to generic and vice versa for formoterol (44.5 vs. 42.1 and 63.5 vs. 53.8) and beclomethasone (93.8 vs. 59.8 and 81.3 vs. 55.9). CONCLUSION Per year, switching between brand and generic inhalation medication was limited to 5% of the patients, switching between device types was observed in 5% as well. Adherence to both generic and brand inhalation medication was low. Effect of switching on adherence was contradictory; depending on time period, medication and type, and direction of switching. Further research on reasons for switching and potential impact on clinical outcomes is warranted.
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Affiliation(s)
- Marjolein Engelkes
- a Department of Medical Informatics , Erasmus MC , Rotterdam , the Netherlands
| | | | - Jetty A Overbeek
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Josephine Kuiper
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Ron C M Herings
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | | | - Johan C de Jongste
- c Department of Pediatrics, Division of Respiratory Medicine and Allergology , Erasmus MC Sophia , Rotterdam , the Netherlands
| | - Katia M C Verhamme
- a Department of Medical Informatics , Erasmus MC , Rotterdam , the Netherlands.,d Department of Bioanalysis, Faculty of Pharmaceutical Sciences , Ghent University , Belgium
| | - Hettie M Janssens
- c Department of Pediatrics, Division of Respiratory Medicine and Allergology , Erasmus MC Sophia , Rotterdam , the Netherlands
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Effect of therapeutic interchange on medication reconciliation during hospitalization and upon discharge in a geriatric population. PLoS One 2017; 12:e0186075. [PMID: 29049325 PMCID: PMC5648145 DOI: 10.1371/journal.pone.0186075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/25/2017] [Indexed: 12/04/2022] Open
Abstract
Background Therapeutic interchange of a same class medication for an outpatient medication is a widespread practice during hospitalization in response to limited hospital formularies. However, therapeutic interchange may increase risk of medication errors. The objective was to characterize the prevalence and safety of therapeutic interchange. Methods and findings Secondary analysis of a transitions of care study. We included patients over age 64 admitted to a tertiary care hospital between 2009–2010 with heart failure, pneumonia, or acute coronary syndrome who were taking a medication in any of six commonly-interchanged classes on admission: proton pump inhibitors (PPIs), histamine H2-receptor antagonists (H2 blockers), hydroxymethylglutaryl CoA reductase inhibitors (statins), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and inhaled corticosteroids (ICS). There was limited electronic medication reconciliation support available. Main measures were presence and accuracy of therapeutic interchange during hospitalization, and rate of medication reconciliation errors on discharge. We examined charts of 303 patients taking 555 medications at time of admission in the six medication classes of interest. A total of 244 (44.0%) of medications were therapeutically interchanged to an approved formulary drug at admission, affecting 64% of the study patients. Among the therapeutically interchanged drugs, we identified 78 (32.0%) suspected medication conversion errors. The discharge medication reconciliation error rate was 11.5% among the 244 therapeutically interchanged medications, compared with 4.2% among the 311 unchanged medications (relative risk [RR] 2.75, 95% confidence interval [CI] 1.45–5.19). Conclusions Therapeutic interchange was prevalent among hospitalized patients in this study and elevates the risk for potential medication errors during and after hospitalization. Improved electronic systems for managing therapeutic interchange and medication reconciliation may be valuable.
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Blandizzi C, Meroni PL, Lapadula G. Comparing Originator Biologics and Biosimilars: A Review of the Relevant Issues. Clin Ther 2017; 39:1026-1039. [DOI: 10.1016/j.clinthera.2017.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 12/30/2022]
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Alefan Q, Karasneh A, El-Dahiyat F, Alshara M, Abu-Naser D. Translation and validation of the Arabic version of generic medicines scale. Res Social Adm Pharm 2016; 13:553-563. [PMID: 27374768 DOI: 10.1016/j.sapharm.2016.05.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Generic drugs are considered the best alternative for the originator brand drugs because they have the same quality, safety, and efficacy yet offered at considerbaly lower cost. Prior research has developed instrumentation to assess patients' perceptions of generic drugs; however, little has been done to translate these measures in other languages. OBJECTIVES This study's aim was to translate and validate an Arabic version of the generic drug scale (GMS) in a Jordanian sample. This was a cross-sectional study. METHODS The English version of the GMS was translated to an Arabic version using the standard "forward-backward" procedure of translation. The questionnaire was distributed to 225 patients. The translated version was then validated in a sample of patients. Face validity of the translated GMS was confirmed with pilot testing. Content validity of the translated GMS was evaluated by a number of pharmacists and academicians. Confirmatory factor analysis (CFA) was used to test a pre-specified relationship of observed measures. RESULTS The GMS consisted of two subscales: efficacy, and similarity of generic drugs to originator brand drugs. The efficacy subscale consisted of ten items while the similarity subscale consisted of six. The responses to the items were framed on five-point, Likert-type scales. The instrument demonstrated good internal consistency (Cronbach's alpha = 0.83). The range model fit was good for some fit indices. The RMSEA value was 0.08, which indicates good fit. Also, CMIN/DF indicated a good fit model with a value of 2.7, as well as GFI and CFI values of 0.95 and 0.91, respectively. NFI and CFI values were 0.92 and 0.93, respectively. Factor loadings were over 0.30 for all items, which means the scale has CFA validity indictors. CONCLUSIONS The Arabic version of GMS was proved to be a reliable and valid measure to investigate patients' belief regarding generic drugs as it showed acceptable, internal consistency reliability, face and content validity.
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Affiliation(s)
- Qais Alefan
- Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Aseel Karasneh
- Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Faris El-Dahiyat
- Facutly of Pharmaceutical Sciences, The Hashemite University, P.O. Box 330127, Zarqa 13133, Jordan
| | - Mohd Alshara
- Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Dania Abu-Naser
- Department of Applied Sciences, Albalqa Applied University, P. O. Box 1293, Irbid 22110, Jordan
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Expert-opinion on non-inferiority margin: A case study of oral anti-coagulant agents for prophylaxis of venous thromboembolic events after orthopedic surgery. Thromb Res 2013; 131:368-71. [DOI: 10.1016/j.thromres.2013.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/05/2012] [Accepted: 01/09/2013] [Indexed: 11/19/2022]
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Chressanthis G, Khedkar P, Jain N, Poddar P, Seiders M. Suppressing Commercial Speech is Not in the Best Interests of Physicians and Patients. J Clin Hypertens (Greenwich) 2013; 15:219-20. [DOI: 10.1111/jch.12043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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