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Serebruany VL, Hall TS, Atar D, Agewall S, Hyun Kim M, Geudelin B, Lomakin N, Marciniak TA. Mortality and adverse events with brand and generic clopidogrel in the US Food and Drug Administration Adverse Event Reporting System. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 5:210-215. [PMID: 30192939 DOI: 10.1093/ehjcvp/pvy035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Aims
Clopidogrel is commonly used even after expiring patents. The brand clopidogrel (BC) was dealt by single company, while numerous manufacturers produce generic clopidogrel (GC). There are no convincing data to compare the safety of different formulations. Therefore, the data yielded from international, uniform, government-mandated registries may be useful.
Methods and results
We assessed primary causative adverse events (PCAE) after BC and GC in the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). The outcomes were divided into death, cardiac, thrombotic/embolic, haemorrhagic, and rash/dermal complications. These primary endpoints were then examined by proportional reporting ratios (PRR) and chi-square (χ2). Among total FAERS (n = 9 466 679) reports, overall BC (n = 88 863) cases were more common than after GC (n = 36 559). When triaged by PCAE role, BC (n = 18 328) was also more abundant than GC (n = 3987). The reported death rates were more than doubled after BC [18.4% vs. 7.0%; PRR = 0.38; 95% confidence interval (95% CI) 0.32–0.43; χ2=369.7; P<0.0001] for total FAERS, and consistent for late 2010–2017 (17.6% vs. 7.0% PRR = 0.40; 95% CI 0.37–0.45; χ2=286.2; P<0.004) PCAE cases. In contrast, GC trended to co-report more cardiac (14.6% vs. 13.3%; PRR = 1.12; 95% CI 1.0–1.25; χ2=3.5; P<0.06). The haemorrhagic (40.9% vs. 32.3%; PRR = 1.45; 95% CI 1.33–1.57; χ2=75.8; P<0.0001), and rash/dermal (5.4% vs. 4.6%; PRR = 1.20; 95% CI 1.0–1.44; χ2=3.75; P<0.05) events were also more common for GC. Thrombotic/embolic events were reported equally (at 7.0%) after each formulation.
Conclusion
The PCAE profiles differ with BC and GC in FAERS. While deaths reports were higher, the rates of cardiac, haemorrhagic, and skin complications were less common for BC. Despite expected reporting bias, this may indicate that the manufacturers of GC are reluctant to report deaths to the FDA. However, the overall adverse event profile suggests potentially better safety of BC over GC formulations.
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Affiliation(s)
- Victor L Serebruany
- Department of Neurology, Stroke Unit, Johns Hopkins University, 14110 Rover Mill Road, West Friendship, MD, USA
| | - Trygve S Hall
- Department of Cardiology B, Oslo University Hospital Ullevål, and University of Oslo, Oslo Norway
| | - Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål, and University of Oslo, Oslo Norway
| | - Stefan Agewall
- Department of Cardiology B, Oslo University Hospital Ullevål, and University of Oslo, Oslo Norway
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University, Busan, South Korea
| | | | - Nikita Lomakin
- Department of Intensive Cardiology, Central Clinical Hospital of the Administrative Affairs of the President of the Russian Federation, Moscow, Russia
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Malmström RE, Godman BB, Diogene E, Baumgärtel C, Bennie M, Bishop I, Brzezinska A, Bucsics A, Campbell S, Ferrario A, Finlayson AE, Fürst J, Garuoliene K, Gomes M, Gutiérrez-Ibarluzea I, Haycox A, Hviding K, Herholz H, Hoffmann M, Jan S, Jones J, Joppi R, Kalaba M, Kvalheim C, Laius O, Langner I, Lonsdale J, Lööv SÄ, Malinowska K, McCullagh L, Paterson K, Markovic-Pekovic V, Martin A, Piessnegger J, Selke G, Sermet C, Simoens S, Tulunay C, Tomek D, Vončina L, Vlahovic-Palcevski V, Wale J, Wilcock M, Wladysiuk M, van Woerkom M, Zara C, Gustafsson LL. Dabigatran - a case history demonstrating the need for comprehensive approaches to optimize the use of new drugs. Front Pharmacol 2013; 4:39. [PMID: 23717279 PMCID: PMC3653065 DOI: 10.3389/fphar.2013.00039] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/20/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There are potential conflicts between authorities and companies to fund new premium priced drugs especially where there are safety and/or budget concerns. Dabigatran, a new oral anticoagulant for the prevention of stroke in patients with non-valvular atrial fibrillation (AF), exemplifies this issue. Whilst new effective treatments are needed, there are issues in the elderly with dabigatran due to variable drug concentrations, no known antidote and dependence on renal elimination. Published studies have shown dabigatran to be cost-effective but there are budget concerns given the prevalence of AF. There are also issues with potentially re-designing anticoagulant services. This has resulted in activities across countries to better manage its use. OBJECTIVE To (i) review authority activities in over 30 countries and regions, (ii) use the findings to develop new models to better manage the entry of new drugs, and (iii) review the implications for all major stakeholder groups. METHODOLOGY Descriptive review and appraisal of activities regarding dabigatran and the development of guidance for groups through an iterative process. RESULTS There has been a plethora of activities among authorities to manage the prescribing of dabigatran including extensive pre-launch activities, risk sharing arrangements, prescribing restrictions, and monitoring of prescribing post-launch. Reimbursement has been denied in some countries due to concerns with its budget impact and/or excessive bleeding. Development of a new model and future guidance is proposed to better manage the entry of new drugs, centering on three pillars of pre-, peri-, and post-launch activities. CONCLUSION Models for introducing new drugs are essential to optimize their prescribing especially where there are concerns. Without such models, new drugs may be withdrawn prematurely and/or struggle for funding.
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Affiliation(s)
- Rickard E. Malmström
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital SolnaStockholm, Sweden
| | - Brian B. Godman
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
- Liverpool Health Economics Centre, University of LiverpoolLiverpool, UK
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK
| | - Eduard Diogene
- Unitat de Coordinació i Estratégia del Medicament, Direcció Adjunta d’Afers Assistencials, Catalan Institute of HealthBarcelona, Spain
| | | | - Marion Bennie
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of StrathclydeGlasgow, UK
- Information Services Division, NHS National Services ScotlandEdinburgh, UK
| | - Iain Bishop
- Information Services Division, NHS National Services ScotlandEdinburgh, UK
| | | | - Anna Bucsics
- Hauptverband der Österreichischen SozialversicherungsträgerWien, Austria
| | - Stephen Campbell
- Centre for Primary Care, Institute of Population Health, University of ManchesterManchester, UK
| | | | - Alexander E. Finlayson
- King’s Centre for Global Health, Global Health Offices, Weston Education CentreLondon, UK
| | - Jurij Fürst
- Health Insurance InstituteLjubljana, Slovenia
| | - Kristina Garuoliene
- Medicines Reimbursement Department, National Health Insurance FundVilnius, Lithuania
| | - Miguel Gomes
- Instituto Nacional da Farmácia e do MedicamentoLisboa, Portugal
| | - Iñaki Gutiérrez-Ibarluzea
- Osteba Basque Office for Health Technology Assessment, Ministry of Health of the Basque CountryDonostia-San Sebastian, Vitoria-Gasteiz, Basque Country, Spain
| | - Alan Haycox
- Liverpool Health Economics Centre, University of LiverpoolLiverpool, UK
| | | | - Harald Herholz
- Kassenärztliche Vereinigung HessenFrankfurt am Main, Germany
| | - Mikael Hoffmann
- Nätverk för läkemedelsepidemiologi, Department of Health Analysis, University HospitalLinköping, Sweden
| | - Saira Jan
- Clinical Programs, Pharmacy Management, Horizon Blue Cross Blue Shield of New JerseyNewark, USA
| | - Jan Jones
- Ninewells Hospital, NHS TaysideDundee, UK
| | - Roberta Joppi
- Pharmaceutical Department, Local Health Unit of VeronaVerona, Italy
| | - Marija Kalaba
- Republic Institute for Health InsuranceBelgrade, Serbia
| | | | - Ott Laius
- State Agency of MedicinesTartu, Estonia
| | | | - Julie Lonsdale
- Lancashire Commissioning Support Unit, Jubilee HouseLeyland, Lancashire, UK
| | - Sven-Äke Lööv
- Department of Healthcare Development, Stockholm County CouncilStockholm, Sweden
| | - Kamila Malinowska
- HTA ConsultingCracow, Poland
- Public Health School, The Medical Centre of Postgraduate EducationWarsaw, Poland
| | - Laura McCullagh
- National Centre for Pharmacoeconomics, St James’s HospitalDublin, Ireland
| | | | - Vanda Markovic-Pekovic
- Faculty of Medicine, University of Banja LukaBanja Luka, Bosnia and Herzegovina, Republic of Srpska
- Ministry of Health and Social WelfareBanja Luka, Bosnia and Herzegovina, Republic of Srpska
| | | | - Jutta Piessnegger
- Hauptverband der Österreichischen SozialversicherungsträgerWien, Austria
| | | | - Catherine Sermet
- Institut de Recherche et Documentation en Économie de la SantéParis, France
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological SciencesLeuven, Belgium
| | - Cankat Tulunay
- President of the Turkish Rational Drug Use PlatformAnkara, Turkey
| | - Dominik Tomek
- Faculty of Pharmacy, Comenius UniversityBratislava, Slovakia
- Faculty of Medicine, Slovak Medical UniversityBratislava, Slovakia
| | | | | | - Janet Wale
- Independent Consumer AdvocateBrunswick, VIC, Australia
| | - Michael Wilcock
- Prescribing Support Unit, c/o Pharmacy Department, Royal Cornwall Hospitals NHS TrustTruro, Cornwall, UK
| | | | | | - Corrine Zara
- Barcelona Health Region, Catalan Health ServiceBarcelona, Spain
| | - Lars L. Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital HuddingeStockholm, Sweden
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Taha AS, Angerson WJ, Prasad R, McCloskey C, Blatchford O. Upper gastrointestinal bleeding and the changing use of COX-2 non-steroidal anti-inflammatory drugs and low-dose aspirin. Aliment Pharmacol Ther 2007; 26:1171-8. [PMID: 17894659 DOI: 10.1111/j.1365-2036.2007.03458.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Rofecoxib was withdrawn in 2004. AIM To assess the incidence of upper gastrointestinal bleeding in the context of the changing use of cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs and low-dose aspirin. METHODS We examined the characteristics of patients developing upper gastrointestinal bleeding in a defined population in south-west Scotland. The primary comparisons were made between two calendar years, preceding and following the withdrawal of rofecoxib. RESULTS The overall incidence of upper gastrointestinal bleeding rose from 98.7 in 2002 to 143 per 10(5) of the population per annum in 2005 (chi(2) = 21.1; P < 0.001). The rise in the incidence was associated with using low-dose aspirin, from 26.6 to 38.4 per 10(5) (chi(2) = 5.4; P = 0.02), other antithrombotic drugs, from 12.1 to 30.2 per 10(5) (chi(2) = 19.6; P < 0.001), and excess alcohol, from 23.5 to 36.4 per 10(5) (chi(2) = 7.1; P = 0.008), but insignificantly with using non-steroidal anti-inflammatory drugs, from 13.3 to 16.1 per 10(5) (chi(2) = 0.64; P = 0.4). After adjustment for the concomitant use of these drugs, there was no significant trend in the incidence of upper gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs over the period of 1996-2005. CONCLUSION The rise in the incidence of upper gastrointestinal bleeding was weakly related to the change in use of non-steroidal anti-inflammatory drugs. Instead, it probably reflected the increasing use of low-dose aspirin, other antithrombotic drugs and alcohol.
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Affiliation(s)
- A S Taha
- Gastroenterology Unit, Crosshouse Hospital, Kilmarnock, UK.
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Kesselheim AS. Intellectual property policy in the pharmaceutical sciences: the effect of inappropriate patents and market exclusivity extensions on the health care system. AAPS JOURNAL 2007; 9:E306-11. [PMID: 17915832 DOI: 10.1208/aapsj0903033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Though patents are effective tools for promoting innovation and protecting intellectual property in the pharmaceutical sciences, there has been growing concern about 2 important ways that patents in this field can have a negative effect on patient care and the practice of medicine. First, inventors can seek and receive patents on pharmaceutical products or research tools that stretch the statutory requirements for patenting. Second, patent holders in the pharmaceutical market can use legal loopholes or aspects of the patent registration system to extend exclusivity for inventions beyond what was anticipated by the Patent Act or subsequent legislation. The monopoly control bestowed by such inappropriate patents or manipulation of the patent system can limit options available to patients, increase the cost of health care delivery, and make cooperative research more difficult. In response, several different government and market-based efforts have emerged to promote more equitable patent policy in health care that encourages dissemination of ideas while still supporting the development of innovative products.
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Affiliation(s)
- Aaron S Kesselheim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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