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Zhao B, Wu J, Lu C, Feng XL. Generic substitution of amlodipine is not associated with increased risk of mortality or adverse cardiovascular events: An observational cohort study. Clin Transl Sci 2024; 17:e13779. [PMID: 38545866 PMCID: PMC10974714 DOI: 10.1111/cts.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
This study aims to assess clinical outcomes following switching from originator to generic amlodipine. This population-based, matched, cohort study included users of originator amlodipine using claims data during 2018-2020 from a health system in Tianjin, China, in which usage of generic amlodipine was promoted by a drug procurement policy, the national volume-based procurement. Non-switchers refer to those remained on originator after the policy, while pure-switchers were those who switched to and continued using generic amlodipine, and back-switchers were those switched to generic amlodipine but then back to the originator. Propensity score matching generates comparable non-switchers and pure-switchers pairs, and non-switchers and back-switchers pairs. The primary outcome was major adverse cardiovascular events (MACEs), defined as all-cause mortality, stroke, and myocardial infarction during follow-up (April 1, 2019 to December 30, 2020). Secondary outcomes included heart failure, atrial fibrillation, and adherence to amlodipine. The hazard ratio (HR) for each clinical outcome was assessed through Cox proportional hazard regression. In total, 5943 non-switchers, 2949 pure-switchers, and 3061 back-switchers were included (mean age: 62.9 years; 55.5% men). For the matched pairs, pure-switchers (N = 2180) presented no additional risks of clinical outcomes compared to non-switchers (N = 4360) (e.g., MACEs: 2.86 vs. 2.95 events per 100 person-years; HR = 0.97 [95%CI: 0.70-1.33]). Back-switchers (N = 1998) also presented no additional risk compared to non-switchers (N = 3996) for most outcomes except for stroke (HR = 1.55 [95%CI: 1.03-2.34]). Pure-switchers and back-switchers all had better amlodipine adherence than non-switchers. Generic substitution of amlodipine is not associated with increased risk of cardiovascular events or all-cause mortality, but improves medicine adherence.
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Affiliation(s)
- Boya Zhao
- School of Pharmaceutical Science and TechnologyTianjin UniversityTianjinChina
- School of Public HealthPeking UniversityBeijingChina
- Center for Social Science Survey and DataTianjin UniversityTianjinChina
| | - Jing Wu
- School of Pharmaceutical Science and TechnologyTianjin UniversityTianjinChina
- Center for Social Science Survey and DataTianjin UniversityTianjinChina
| | - Chengzhi Lu
- Department of CardiologyTianjin First Central HospitalTianjinChina
| | - Xing Lin Feng
- School of Public HealthPeking UniversityBeijingChina
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Wang X, He X, Zhang P, Zhang M, Ma R, Dai R, Li X. The impact of the national volume-based procurement policy on the use of policy-related drugs in Nanjing: an interrupted time-series analysis. Int J Equity Health 2023; 22:200. [PMID: 37770924 PMCID: PMC10540346 DOI: 10.1186/s12939-023-02006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND In September 2019, the "4 + 7" centralized procurement pilot program was expanded nationwide aiming at reducing drug prices by means of volume-based procurement and using accredited generic drugs for branded drug substitutes. Given the current uncertain effect of the policy outside pilot areas, this study was conducted to evaluate the impact of the National Volume-based Procurement policy on the use of policy-related drugs after expansion. METHOD A single-group interrupted time series was applied using drug purchase data, covering 25 months from December 2018 to December 2020. Drugs related to the centralized procurement policy were selected as samples, including 25 first-batch policy-related drugs and 56 alternative drugs. Centralized procured drugs can be divided into bid-winning and non-winning products, where non-winning products were sorted into generic and branded drugs, and alternative products were classified according to different degrees of substitution. Purchase volume, expenditures, and daily costs were measured. RESULTS After the implementation of the policy, a significant increase was associated with the volume of bid-winning drugs (p < 0.001) and the volume of generic and branded drugs decreased immediately. The DDDc of drugs under the same generic name significantly reduced (an instantaneous drop of bid-winning drugs by approximately 25%, 7.62 CNY for generics and 3.07 CNY for branded drugs), saving 48.2 million CNY of drug expenditures. The policy has a significant effect on the drug for the treatment of cardiovascular diseases and exerted little influence on the drug for the treatment of nervous diseases, and the substitution of generics for antitumor-branded drugs was not obvious. In addition, the procurement volume of alternative drugs appeared to be a "carry-over". CONCLUSIONS These findings indicated that the policy demonstrated positive effects in terms of price reductions and cost savings and accelerated the substitution of generics against branded drugs. The "patent cliff" for branded drugs has gradually emerged. Besides, a short-term "spillover effect" of the volume of alternative drugs was observed, requiring special attention and vigilance.
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Affiliation(s)
- Xiao Wang
- School of Health Policy and Management, Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, P.R. China, 211166
- Department of Science and Technology, Wuxi No.2 People's Hospital, Wuxi, China
| | - Xuan He
- School of Health Policy and Management, Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, P.R. China, 211166
- Wuxi Xinwu District Center for Health Promotion and Education, Wuxi, China
| | - Pei Zhang
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Mengdie Zhang
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Rui Ma
- School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Rouli Dai
- National Institute of Drug Clinical Trials, the Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, P.R. China, 211166.
- School of Pharmacy, Nanjing Medical University, Nanjing, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
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Pettersen TR, Schjøtt J, Allore HG, Bendz B, Borregaard B, Fridlund B, Larsen AI, Nordrehaug JE, Rotevatn S, Wentzel-Larsen T, Norekvål TM. Perceptions of generic medicines and medication adherence after percutaneous coronary intervention: a prospective multicentre cohort study. BMJ Open 2022; 12:e061689. [PMID: 36127123 PMCID: PMC9490600 DOI: 10.1136/bmjopen-2022-061689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine patient perceptions of generic medicines 2 and 6 months after percutaneous coronary intervention (PCI), and to determine whether these perceptions moderate medication adherence. DESIGN Prospective multicentre cohort study with repeated measures of perceptions of generic medicines and medication adherence. SETTING The CONCARDPCI study conducted at seven large referral PCI centres in Norway and Denmark between June 2017 and May 2020. PARTICIPANTS A total of 3417 adults (78% men), using both generic and brand name medicines, with a mean age of 66 years (SD 11) who underwent PCI were followed up 2 and 6 months after discharge from hospital. MAIN OUTCOME MEASURES Perceptions of generic medicines were the main outcome. The secondary outcome was medication adherence. RESULTS Perceptions of generic medicines were significantly more negative at 2 than at 6 months (1.10, 95% CI 0.41 to 1.79, p=0.002). Female sex (-4.21, 95% CI -6.75 to -1.71, p=0.001), older age (-0.12, 95% CI -0.23 to -0.02, p=0.020), lower education level (overall p<0.001), ethnicity (overall p=0.002), Norwegian nationality (10.27, 95% CI 8.19 to 12.40, p<0.001) and reduced self-reported health status (0.19, 95% CI 0.09 to 0.41, p=0.003) were significantly associated with negative perceptions of generic medicines. There was no evidence to suggest that perceptions of generic medicines moderate the association between sociodemographic and clinical variables and medication adherence (p≥0.077 for all covariates). Moreover, self-reported medication adherence was high, with 99% scoring at or above the Medication Adherence Report Scale midpoint at both time points. There were no substantial correlations between negative perceptions of generic medicines and medication non-adherence at 2 months (r=0.041, 95% CI 0.002 to 0.081, p=0.037) or 6 months (r=0.038, 95% CI -0.005 to 0.081, p=0.057). CONCLUSIONS Mistrust and uncertainty about the safety and efficacy of generic medicines remains in a sizeable proportion of patients after PCI. This applies especially to those of lower socioeconomic status, older age, female sex, immigrants and those with poorer mental health. However, this study demonstrated a shift towards more positive perceptions of generic medicines in the longer term.
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Affiliation(s)
- Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Jan Schjøtt
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Oslo, Norway
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Kalmar, Sweden
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Centre for Child and Adolescent Mental Health Eastern and Southern Norway, Oslo, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
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Leonova MV. Clinical equivalence of generic and brand-name drugs used in cardiology: what do we know? CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The problem of using generics in the treatment of patients with cardiovascular diseases remains relevant for more than a decade. The concern of doctors, pharmacists and patients is not diminishing with the constant rise in cardiovascular morbidity and mortality worldwide. Based on a systematic review of 186 publications, physicians identified concerns about the quality, reliability and replaceability of original drugs; pharmacists have shown the highest level of generic approval. Patients distrust of generics was revealed, caused by a lack of information, concerns about packaging, and negative experience of replacing the original drug. Three meta-analyzes compared generic and original drugs of cardiovascular groups in terms of efficacy and safety. A 2008 meta-analysis (47 studies, 9 classes of cardiovascular drugs) assessed the effect on mild outcomes, a 2016 meta-analysis (74 studies, 7 classes of drugs) also assessed side effects. The cumulative effect revealed a small and nonsignificant difference, which indicated that there was no superiority of original drugs over generics; there were no differences in the frequency and severity of side effects between generics and original drugs. A 2020 meta-analysis (72 studies, 9 drug classes) assessed the frequency of hospital admissions (including emergency department consultations, hospitalizations) and found a significant increase in the risk for generics for any reason (14%), but not for cardiac vascular diseases. A review of 8 cohort studies evaluating antihypertensive drugs for long-term cardiovascular outcomes, duration of retention, and substitution effect did not find significant differences between generics and brands. In a systematic review of studies comparing warfarin and generics, there were no significant differences in international normalized ratio and the incidence of thromboembolic and hemorrhagic complications; however, in one study, the frequency of hospital visits was 10% higher for generics. A systematic review of studies comparing clopidogrel versus generics shows drug comparability for major cardiovascular events and mortality. A review of 5 cohort studies evaluating originator statins and generics showed comparable rates of all-cause mortality and major cardiovascular events, except for one study with conflicting results. Meta-analyzes and large observational studies indicate that generics are not the worst efficacy, sometimes even surpass that of original drugs and can be justifiably used in clinical practice.
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AlShoaibi N, Al Harbi M, Modaimegh H, Al Qubbany A, Al Saif S, Connolly DL, Kharabsheh S, Fathy M, Hegazy Y, Tarcha N, Al Fagih A. Use of NOACS in high-risk patients with atrial fibrillation in Saudi Arabia: Perspectives on improving patient care. Expert Rev Cardiovasc Ther 2021; 19:221-236. [PMID: 33475462 DOI: 10.1080/14779072.2021.1878878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Despite the widespread and increasing use of NOACs in Saudi Arabia, there is a lack of contemporary guidance specific to the region. In particular, guidance on NOAC use in high-risk patients who are more likely to experience bleeding with oral anticoagulant therapy is needed. There is an unmet need for a review of contemporary evidence coupled with expert insights on safe and effective NOAC use in high-risk patients with AF in Saudi Arabia. RESEARCH DESIGN AND METHODS This article provides a detailed review of contemporary literature on NOAC use in high-risk patients with AF. Additionally, key gaps in the literature are identified and expert insights are shared to guide effective management of patients and the significance of local data is evaluated with respect to challenges in optimizing the use of NOACs. CONCLUSIONS This article provides information that complements and expands on existing reviews and guidelines on NOAC use in patients with AF, with a focus on challenges specific to the Saudi Arabian context with the potential to make a positive contribution to the medical community in Saudi Arabia and in other nations.
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Affiliation(s)
| | - M Al Harbi
- King Fahad Specialist Hospital, Dammam KSA
| | | | - A Al Qubbany
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Research Center, Jeddah, KSA.,Ministry of National Guard, KSA
| | | | - D L Connolly
- Birmingham City Hospital & the Institute of Cardiovascular Sciences, University of Birmingham, UK
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Westphal ES, Aladeen T, Vanini D, Rainka M, McCadden K, Gengo FM, Bates V. Generic Clopidogrel: Has Substitution for Brand Name Plavix® Been Effective? J Pharm Pract 2021; 35:536-540. [PMID: 33648379 DOI: 10.1177/0897190021997006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Following the expiration of brand name exclusivity of Plavix® in 2012, generic clopidogrel bisulfate was approved. As a widely prescribed medication with significant inter-patient pharmacokinetic and pharmacodynamic variability, data regarding the impact of switching to generic clopidogrel bisulfate on patients is needed. OBJECTIVE The objective of this study was to determine whether generic clopidogrel bisulfate is as efficacious as Plavix® for the inhibition of platelet aggregation. METHODS Patients treated with Plavix® monotherapy (n = 254) or generic clopidogrel bisulfate monotherapy (n = 185) were included in this retrospective review. Confounding factors previously found to affect clopidogrel responsiveness (diabetes, female sex, and smoking) were assessed, as well as medications classified as substrates, inducers, and inhibitors of enzymes involved in clopidogrel metabolism. Whole blood impedance aggregometry was used to measure platelet aggregation in response to adenosine diphosphate. Patients were tested after ≥2 weeks of treatment and designated as non-responders if aggregation response exceeded sensitivity thresholds of 6 ohms of impedance. RESULTS The introduction of generic clopidogrel bisulfate was associated with a decrease in antiplatelet resistance (44% to 31%, p < 0.01) and decreased mean ohms of resistance (5.06 ± 4.55 to 3.32 ± 4.03, p < 0.01). Prior to analysis of secondary outcomes, 217 patients were eliminated due to antiplatelet usage for longer than 3 years (n = 123 for Plavix® and n = 118 for clopidogrel). There was no statistically significant finding in prevalence of secondary events. CONCLUSION Resistance rates to the antiplatelet, clopidogrel are significantly lower since the switch to generic formulations. Further investigation into the impact of variability between clopidogrel bisulfate formulations is needed.
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Affiliation(s)
| | | | - Denis Vanini
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | | | - Kaitlin McCadden
- University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Francis M Gengo
- Dent Neurologic Institute, Amherst, NY, USA.,University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Vernice Bates
- Dent Neurologic Institute, Amherst, NY, USA.,University at Buffalo, Buffalo, NY, USA
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Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China. Chin Med J (Engl) 2021; 134:292-301. [PMID: 33470655 PMCID: PMC7846498 DOI: 10.1097/cm9.0000000000001360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Generic drugs are bioequivalent to their brand-name counterparts; however, concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies. The purpose of this study was to evaluate the long-term antihypertensive efficacy, cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs. METHODS In a multicenter, community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years, we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2, 2176 patients using brand-name drugs and 4352 patients using generic drugs. RESULTS There were no significant differences between generic drugs and brand-name drugs in blood pressure (BP)-lowering efficacy, BP control rate, and cardiovascular outcomes including coronary heart disease and stroke. The adjusted mean (95% confidence interval [CI]) of systolic BP (SBP)-lowering was -7.9 mmHg (95% CI, -9.9 to -5.9) in the brand-name drug group and -7.1 mmHg (95% CI, -9.1 to -5.1) in the generic drug group after adjusting for age, sex, body mass index, number of antihypertensive drugs and traditionally cardiovascular risk factors. Among patients aged <60 years, brand-name drugs had a higher BP control rate (47% vs. 41%; P = 0.02) and a greater effect in lowering SBP compared with generic drugs, with the between-group difference of 1.5 mmHg (95% CI, 0.2-2.8; P = 0.03). BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs (46% vs. 40%; P = 0.01). Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of $315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment. CONCLUSIONS Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits, especially in low- and middle-income areas.
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Mattiazzi P, Bohrer D, Viana C, Becker E. Assessment of Purity Parameters of Generic and Brand Name Losartan Potassium. CURR PHARM ANAL 2020. [DOI: 10.2174/1573412915666190911091218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Generic products must be bioequivalent to the innovator brand product. Nevertheless,
in addition to meeting bioequivalence standards, attention must be paid to the content of the
active substance and contaminants in generic drugs.
Objective:
This study compared the pharmaceutical quality of four generic losartan potassium formulations
with the brand-name product: Cozaar®.
Methods:
The United States Pharmacopeia (USP) losartan potassium standard was used as reference
material. The products tested (all 50 mg formulations) included four generic tablet formulations and the
innovator brand product Cozaar®. Active substance content, organic impurities, and elemental impurities
were assessed following the USP monograph for losartan potassium tablets and USP Chapter
<233> on Elemental Impurities.
Results:
The results showed that three of the four generic products had low content of the active ingredient.
The values ranged from 86.4 to 93.8%, being acceptable not below 95% of the labeled amount.
Organic impurities were not detected in any of the products, and of the 13 elemental impurities tested,
only four elements were detected. The elemental impurities Cr, Ni, Cu, and As were, however, in
amounts within the limits established by the USP monograph. The only concern on the generic drugs
analyzed was the low content of the active ingredient in 75% of the products.
Conclusion:
Since losartan is a drug of continuous use, lower content of the active ingredient may go
unnoticed by the users of the generic product and entailed clinical consequences during long-term therapy.
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Affiliation(s)
- Patricia Mattiazzi
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Santa Maria, Av. Roraima, 1000, 97105-900 Santa Maria, Brazil
| | - Denise Bohrer
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Santa Maria, Av. Roraima, 1000, 97105-900 Santa Maria, Brazil
| | - Carine Viana
- Postgraduate Program in Pharmaceutical Sciences, Federal University of Santa Maria, Av. Roraima, 1000, 97105-900 Santa Maria, Brazil
| | - Emilene Becker
- Institut of Chemistry, Federal University of Rio Grande do Sul, AC Campus da UFRGS, Agronomia 91501-970 Porto Alegre, Brazil
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Aretha D, Kiekkas P, Sioulas N, Fligou F. Differences in brand versus generic esmolol in the treatment of perioperative supraventricular tachycardia and hypertension: A pilot study. SAGE Open Med 2020; 8:2050312120962338. [PMID: 33062276 PMCID: PMC7533938 DOI: 10.1177/2050312120962338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background: Once a patent expires, generic analogue drugs are alternatives to brand name drugs. Because bioequivalence/biodistribution problems have been reported for many generic analogue drugs, we prospectively evaluated 31 patients to reveal the differences in the doses used and the efficacy and adverse events of two different intravenous esmolol formulations. Methods: This was a prospective observational pilot study. Our aim was to reveal the possible differences in the required doses between two different formulations (brand name drug vs generic analogue drug) of intravenous esmolol in beats per minute, systolic blood pressure, diastolic blood pressure and mean arterial pressure in intra- and postoperative patients with supraventricular tachycardia and hypertension. The patients were categorised into two groups according to the medication they received (brand name drug or generic analogue drug). Results: Esmolol was given to 31 patients (16 generic analogue drug and 15 brand name drug). Although there was a statistically significant difference in bolus (mg/kg) and continued (mg/kg/h) drug dose used (brand name drug/generic analogue drug, mean (standard deviation), 0.3 (0.1) vs 0.38 (0.1), p = 0.03 for bolus dose, and 0.22 (0.09) vs 0.29 (0.08) for continued dose at 10 min (p = 0.03), 0.19 (0.06) vs 0.24 (0.05) at 20 min (p = 0.01) and 0.14 (0.05) vs 0.18 (0.05) at 30 min (p = 0.02)), there were no time-related statistical significant differences in the reduction rates of the two drugs (p = 0.47). There were no time-related statistically significant differences between the two groups in systolic blood pressure, diastolic blood pressure, mean arterial pressure and beats per minute, nor in their adverse events. Conclusion: In this pilot study, smaller doses were given for controlling the patient’s haemodynamics when a brand name drug was used. Because there were no significant time-related differences in the reduction rates of the two drugs nor in any haemodynamic differences between the two groups, optimal titration of the drug used could effectively control the patient’s haemodynamics. The adverse events were also similar in both groups.
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Affiliation(s)
- Diamanto Aretha
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, University Hospital of Patras, Patras, Greece
| | | | | | - Fotini Fligou
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, University Hospital of Patras, Rion, Patras, Greece
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Tung YC, Hsu TJ, Lin CP, Hsiao FC, Chu YC, Chen WJ, Chu PH. Efficacy and safety outcomes of one generic nifedipine versus ADALAT long-acting nifedipine for hypertension management. J Clin Hypertens (Greenwich) 2020; 22:2296-2305. [PMID: 33035392 DOI: 10.1111/jch.14070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
Data regarding the long-term outcomes of generic antihypertensive drugs are limited. This nationwide retrospective database analysis aimed to evaluate the efficacy and safety of a generic versus brand-name nifedipine for hypertension treatment. Patients who were prescribed generic or brand-name nifedipine between January 1, 2008, and December 31, 2013, were identified from the National Health Insurance Research Database of Taiwan. The efficacy outcomes included all-cause mortality and the composite cardiovascular (CV) outcome, including CV death, non-fatal myocardial infarction, non-fatal stroke, coronary revascularization, and hospitalization for heart failure. Safety outcomes included headache, peripheral edema, constipation, acute kidney injury, hypotension, syncope, new diagnosis of cancer, and cancer death. Among the 98 335 patients who were eligible for analysis, 21 087 (21.4%) were prescribed generic nifedipine. Both the generic and the brand-name groups included 21 087 patients after propensity score matching. At a mean follow-up of 4.1 years, the generic nifedipine was comparable to the brand-name drug with regard to all-cause mortality (7.2% vs. 7.1%; hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.95-1.09) and the composite CV outcomes (11.6% vs. 11.9%; HR 0.97; 95% CI 0.92-1.03). The generic nifedipine was associated with higher rates of headache, peripheral edema, and constipation but a modest reduction in the risk of newly diagnosed cancer (7.1% vs. 7.8%; subdistribution HR 0.90, 95% CI 0.84-0.97). The risks of acute kidney injury, hypotension, syncope, and cancer death were not significantly different between the two groups. In conclusion, the generic nifedipine was comparable to the brand-name drug with regard to the risks of all-cause mortality and the composite CV outcome. The finding of cancer risk could be chance and should be interpreted with caution.
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Affiliation(s)
- Ying-Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Tzyy-Jer Hsu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chia-Pin Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Fu-Chih Hsiao
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - You-Chia Chu
- Department of Computer Science, National Chiao-Tung University, Hsien-Chu, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Leclerc J, Poirier P. Corporate Lobbyists: Open Season on Academic Health Science? Can J Cardiol 2020; 37:182-183. [PMID: 32376284 DOI: 10.1016/j.cjca.2020.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jacinthe Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Canada; Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada.
| | - Paul Poirier
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
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Leclerc J, Blais C, Rochette L, Hamel D, Guénette L, Beaudoin C, Poirier P. Public Health Outcomes May Differ After Switching from Brand-Name to Generic Angiotensin II Receptor Blockers. Drugs R D 2020; 20:135-145. [PMID: 32342284 PMCID: PMC7221012 DOI: 10.1007/s40268-020-00307-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background It is unclear whether generics are as safe as brand-name drugs in cardiology. For public health surveillance purposes, we evaluated if switching from the brand-name losartan, valsartan, or candesartan impacted the occurrence of the following outcomes: emergency room (ER) consultations, hospitalizations, or death. Study Design This was a retrospective cohort study. Methods This study was conducted in the Quebec Integrated Chronic Disease Surveillance System, including healthcare administrative data of the population of Quebec, Canada. We included brand-name users of losartan, valsartan, or candesartan aged ≥ 66 years who had undergone ≥ 30 days of stable treatment on the brand-name drug prior to cohort entry (substitution time-distribution matching was used to prevent immortal time bias). Outcomes up to 1 year were compared between groups using multivariable Cox proportional hazards regression models (validity assumptions were verified). Results In our cohorts (losartan, n =15,783; valsartan, n =16,907; candesartan, n =26,178), mean age was 76–78 years, 59–66% were female, 90–92% had hypertension, and 13–15% had heart failure. Validity assumptions were violated for losartan only. For patients switched to generic valsartan, the hazard ratio (95% confidence interval) was 1.07 (0.99–1.14) for ER consultation, 1.26 (1.14–1.39) for hospitalization, and 1.01 (0.61–1.67) for death. The corresponding rates for candesartan were 1.00 (0.95–1.05), 0.96 (0.89–1.03), and 0.57 (0.37–0.88), respectively. Conclusions We observed an increased risk of hospitalizations for patients switched to generic valsartan, and a decreased risk of death for patients switched to generic candesartan, compared with those who continued taking the brand-name drug. The differences between generic and brand-name drugs may lead to some differences in public health outcomes, but this safety signal must be further studied using other cohorts and settings. Electronic supplementary material The online version of this article (10.1007/s40268-020-00307-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jacinthe Leclerc
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada. .,Département des Sciences infirmières, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Local 4849, Santé, Trois-Rivières, QC, G9A 5H7, Canada. .,Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Claudia Blais
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada.,Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada
| | - Louis Rochette
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada
| | - Line Guénette
- Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Quebec City, QC, Canada
| | - Claudia Beaudoin
- Institut national de santé publique du Québec, Bureau d'information et d'études en santé des populations, Quebec, QC, Canada.,Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Quebec City, QC, Canada.,Faculté de médecine, Université Laval, Quebec City, QC, Canada
| | - Paul Poirier
- Faculté de Pharmacie, Université Laval, Quebec City, QC, Canada.,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada
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13
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Are Generic Drugs Used in Cardiology as Effective and Safe as their Brand-name Counterparts? A Systematic Review and Meta-analysis. Drugs 2020; 80:697-710. [PMID: 32279239 DOI: 10.1007/s40265-020-01296-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous systematic reviews (2008; 2016) concluded similarity in outcomes between brand-name and generic drugs in cardiology, but they included ≥ 50% comparative bioavailability studies, not designed or powered to detect a difference in efficacy or safety between drug types. We aimed to summarise best-evidence regarding the effectiveness and safety of generic versus brand-name drugs used in cardiology. METHODS For this systematic review of the literature, scientific databases (MEDLINE and EMBASE) were searched from January 1984 to October 2018. Original research reports comparing the clinical impact of brand-name versus generic cardiovascular drugs on humans treated in a real-life setting, were selected. Meta-analyses and subgroup analyses were performed. Heterogeneity (I2) and risk of bias were tested. RESULTS Among the 3148 screened abstracts, 72 met the inclusion criteria (n ≥ 1,000,000 patients, mean age 65 ± 10 years; 42% women). A total of 60% of studies showed no difference between drug types, while 26% concluded that the brand-name drug was more effective or safe, 13% were inconclusive and only 1% concluded that generics did better. The overall crude risk ratio of all-cause hospital visits for generic versus brand-name drug was 1.14 (95% confidence interval: 1.06-1.23; I2: 98%), while it was 1.05 (0.98-1.14; I2: 68%) for cardiovascular hospital visits. The crude risk ratio was not statistically significant for randomised controlled trials only (n = 4; 0.92 [0.63-1.34], I2: 35%). CONCLUSION The crude risk of hospital visits was higher for patients exposed to generic compared to brand-name cardiovascular drugs. However, the evidence is insufficient and too heterogeneous to draw any firm conclusion regarding the effectiveness and safety of generic drugs in cardiology.
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14
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John M. More Vigilance on Generic Drugs are Necessary. Indian J Endocrinol Metab 2020; 24:215-216. [PMID: 32699793 PMCID: PMC7333761 DOI: 10.4103/ijem.ijem_646_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/06/2020] [Accepted: 03/26/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mathew John
- Providence Endocrine and Diabetes Specialty Centre, Prasanth Nagar, Ulloor, Trivandrum, Kerala, India
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Leclerc J, Blais C, Rochette L, Hamel D, Guénette L, Poirier P. Trends in Hospital Visits for Generic and Brand-Name Warfarin Users in Québec, Canada: A Population-Based Time Series Analysis. Am J Cardiovasc Drugs 2019; 19:287-297. [PMID: 30471054 DOI: 10.1007/s40256-018-0309-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Federal standards authorize the commercialization of generic medicines after bioequivalence versus the brand-name originator has been demonstrated. For drugs with narrow therapeutic indexes, such as warfarin, the accepted difference in bioavailability is ≤ 10%. No systematic pharmacovigilance studies are conducted once generics become available. OBJECTIVE We aimed to assess the impact of the arrival of generic warfarin on hospital visit trends (hospital admissions or emergency room consultations) in warfarin users. METHODS This was an observational interrupted time series analysis (2 January 1996 to 1 January 2016). Using the Québec Integrated Chronic Disease Surveillance System, we included all patients who were aged ≥ 66 years, publicly covered and using brand-name or generic warfarin (N = 280,158). We estimated rates of hospital visits in 6-month periods, 5 years before and up to 15 years after the arrival of generic warfarin. Periods before and after were compared using segmented regression models for all users along with exploratory (generic vs. brand name)/subgroup analyses (cardiovascular comorbidities and socioeconomic status). RESULTS Generic warfarin arrived on the market on 2 January 2001. Over the 20-year period of the study, the mean rate of hospital visits was 113 for 100 brand-name or generic users per 6-month period and was similar before and after the arrival of the generics. Up to 15 years after the arrival of the generics, the rates of hospital visits were 10% higher for generic than for brand-name users, which was confirmed by subgroup analyses. CONCLUSIONS Overall, we observed no impact on hospital visits after the arrival of generic warfarin in all the population treated with any type of warfarin. However, a higher crude rate of hospital visits among generic users than brand-name users remains to be validated using a different methodology and specific outcomes.
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Affiliation(s)
- Jacinthe Leclerc
- Institut National de Santé Publique du Québec, Bureau D'information et D'études en Santé des Populations, Quebec, QC, Canada
- Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Claudia Blais
- Institut National de Santé Publique du Québec, Bureau D'information et D'études en Santé des Populations, Quebec, QC, Canada
- Faculty of Pharmacy, Université Laval, Quebec, QC, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Bureau D'information et D'études en Santé des Populations, Quebec, QC, Canada
| | - Denis Hamel
- Institut National de Santé Publique du Québec, Bureau D'information et D'études en Santé des Populations, Quebec, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Quebec, QC, Canada
- Axe Santé des Populations et Pratiques Optimales en Santé, CHU de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Paul Poirier
- Faculty of Pharmacy, Université Laval, Quebec, QC, Canada.
- Research Center, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Quebec, G1V 4G5, QC, Canada.
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Leclerc J, Blais C, Rochette L, Hamel D, Guénette L, Poirier P. Did Generic Clopidogrel Commercialization Affect Trends of ER Consultations and Hospitalizations in the Population Treated with Clopidogrel? Drugs Aging 2019; 36:759-768. [PMID: 31073846 DOI: 10.1007/s40266-019-00679-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clopidogrel has been widely used to prevent atherothrombotic events. Since 2011, pharmacists have offered their patients the opportunity to switch to generic clopidogrel, an economic alternative. Whether bioequivalence of generic cardiovascular drugs translates into clinical equivalence at a population level remains unclear and needs to be further documented. OBJECTIVE We aimed to evaluate the impact of generic clopidogrel commercialization on adverse events (AEs): hospitalizations or emergency room (ER) consultations. METHODS This is an interrupted time series analysis using the Quebec Integrated Chronic Disease Surveillance System. We included all patients ≥ 66 years old who were users of the brand-name clopidogrel or a generic version (n = 6) 24 months before and up to 12 months after generics commercialization. Rates of AEs were computed, and periods before and after generics commercialization were analyzed by segmented regression models along with exploratory analyses (generic vs. brand name). Sensitivity analyses were also performed using stratification of the time series by (1) sex, (2) the number of prevalent cardiovascular comorbidities, and (3) socioeconomic status. RESULTS Time series were constituted of 89,525 clopidogrel users (mean age 78 years, 45% women, 71% ischemic heart disease, 34% stroke). For all users, there was a mean rate of 157 AEs per 1000 user-months, stable trend before (-0.1% [95% confidence interval -0.3 to 0.1] and after (0.0% [- 0.5 to 0.6]) generics commercialization. In exploratory analyses, once generic clopidogrel versions were commercialized, rates of AEs were 19.2% (95% CI 11.7-26.7) higher for generic versus brand-name users. This difference persisted up to 1 year. Sensitivity analyses yielded similar results. CONCLUSIONS The population treated with clopidogrel had similar rates of hospitalizations or ER consultations before and after generics commercialization. However, differences in rates of hospitalizations or ER consultations between generic and brand-name clopidogrel users may represent a drug safety signal which remains to be validated. Using a different study design, permitting adjustment for potential confounders, could be useful in this regard.
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Affiliation(s)
- Jacinthe Leclerc
- Institut national de santé publique du Québec, Quebec City, Canada.,Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.,Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Canada
| | - Claudia Blais
- Institut national de santé publique du Québec, Quebec City, Canada.,Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada
| | - Louis Rochette
- Institut national de santé publique du Québec, Quebec City, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, Quebec City, Canada
| | - Line Guénette
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.,Centre de recherche du CHU de Québec-Université Laval, Axe Santé des populations et pratiques optimales en santé, Quebec City, Canada
| | - Paul Poirier
- Faculty of Pharmacy, Université Laval, Quebec City, QC, Canada.
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Evidence of a Media-Induced Nocebo Response Following a Nationwide Antidepressant Drug Switch. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.29642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In 2017, patients on a generic or branded antidepressant venlafaxine were switched to a new generic formulation (Enlafax). In February and April 2018, two major NZ media outlets
ran stories about the new generic being less effective and causing specific side effects. This study aimed to examine the effect of the media coverage on drug side effects
reported to the national Centre for Adverse Reactions Monitoring (CARM) and whether the specific symptoms reported in the media increased compared to side effects not reported
in the media.
We analysed monthly adverse reaction reports for Enlafax to CARM from October 2017 to June 2018 and compared adverse reports, complaints of decreased therapeutic effect and
specific symptom reports before and after the media coverage using an interrupted time series analysis.
We found the number of side effects and complaints of reduced therapeutic effect increased significantly following the media stories (interruption effect = 41.83, 95% CI [25.25,
58.41], p = .003; interruption effect = 15.49, 95% CI [7.01, 23.98], p = .012, respectively). The specific side effects mentioned in the media coverage, including suicidal
thoughts, also increased significantly compared to other side effects not mentioned in the media.
In the context of a drug switch, media reports of side effects appear to cause a strong nocebo response by increasing both the overall rate of side effect reporting and an
increase in the specific side effects mentioned in the media coverage, including reduced drug efficacy and heightened suicidal thoughts.
The study provides further evidence that media coverage of side effects can induce a nocebo effect.
This is the first study to look at media coverage of an antidepressant brand switch.
The increase in reported adverse events was higher for those symptoms mentioned in the media reports.
The study provides further evidence that media coverage of side effects can induce a nocebo effect.
This is the first study to look at media coverage of an antidepressant brand switch.
The increase in reported adverse events was higher for those symptoms mentioned in the media reports.
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Sicras-Mainar A, Rejas-Gutiérrez J, Pérez-Paramo M, Sánchez-Alvarez L, Navarro-Artieda R, Darbà J. Consequences on economic outcomes of generic versus brand-name drugs used in routine clinical practice: the case of treating peripheral neuropathic pain or generalized anxiety disorder with pregabalin. Expert Rev Pharmacoecon Outcomes Res 2018; 19:45-57. [PMID: 30182806 DOI: 10.1080/14737167.2019.1519399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Discrepancies are seen between arguments in favor of and against prescribing generic versus brand-name drugs. OBJECTIVE To provide real-world evidence on treatment persistence, economic and clinical outcomes of pregabalin, generic versus brand-name (Lyrica®, Pfizer), routinely used to treat neuropathic pain (NP) or generalized anxiety disorder (GAD). METHODS Electronic medical records from subjects' first starting treatment with pregabalin between January-2015 and June-2016 were analyzed. Persistence, resources utilization, and costs were assessed, along with remitter and responder rates. RESULTS A total of 4860 records were analyzed. Discontinuation was lower with brand-name than with generic in NP (adjusted hazard ratio [HR]: 0.70 [95% CI: 0.58-0.85], p < 0.001) and GAD patients (HR: 0.63 [0.45-0.84], p < 0.001). Adjusted mean total costs were lower with brand-name: €1500 [1428-1573] vs. €2003 [1864-2143] in NP and €1528 [1322-1734] vs. €2150 [1845-2454] in GAD (both p < 0.001). More patients were remitters/ responders with brand-name in NP (55.0% vs. 46.7% and 59.2% vs. 48.4%, respectively; p < 0.001) and GAD (58.6% vs. 48.7% and 64.6% vs. 47.2%, respectively; p < 0.001). CONCLUSIONS As a consequence of higher persistence in routine practice, patients who first started therapy with pregabalin brand-name versus generic showed better pain or anxiety outcomes at a lower cost to payers in Spain.
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Affiliation(s)
| | | | | | - Luis Sánchez-Alvarez
- d Primary Care Pharmacy Directorate, Avilés Primary Care Center , Avilés , Spain
| | - Ruth Navarro-Artieda
- e Department of Medical Documentation , Hospital Germans Trias i Pujol , Badalona , Spain
| | - Josep Darbà
- f Department of Economics , Universitat de Barcelona , Barcelona , Spain
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Alter DA. When Do We Decide That Generic and Brand-Name Drugs Are Clinically Equivalent? Perfecting Decisions With Imperfect Evidence. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004158. [PMID: 28974513 DOI: 10.1161/circoutcomes.117.004158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David A Alter
- From the University Health Network-Toronto Rehabilitation Institute (UHN-TRI), ON, Canada; and Department of Medicine, Institute for Clinical Evaluative Sciences (ICES), University of Toronto, ON, Canada.
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