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Sandes V, Figueras A, Lima EC. Pharmacovigilance Strategies to Address Resistance to Antibiotics and Inappropriate Use-A Narrative Review. Antibiotics (Basel) 2024; 13:457. [PMID: 38786184 PMCID: PMC11117530 DOI: 10.3390/antibiotics13050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
The spread of antimicrobial resistance (AMR) is a global challenge. Close and continuous surveillance for quick detection of AMR can be difficult, especially in remote places. This narrative review focuses on the contributions of pharmacovigilance (PV) as an auxiliary tool for identifying and monitoring the ineffectiveness, resistance, and inappropriate use of antibiotics (ABs). The terms "drug ineffective", "therapeutic failure", "drug resistance", "pathogen resistance", and "multidrug resistance" were found in PV databases and dictionaries, denoting ineffectiveness. These terms cover a range of problems that should be better investigated because they are useful in warning about possible causes of AMR. "Medication errors", especially those related to dose and indication, and "Off-label use" are highlighted in the literature, suggesting inappropriate use of ABs. Hence, the included studies show that the terms of interest related to AMR and use are not only present but frequent in PV surveillance programs. This review illustrates the feasibility of using PV as a complementary tool for antimicrobial stewardship activities, especially in scenarios where other resources are scarce.
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Affiliation(s)
- Valcieny Sandes
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho-373, Rio de Janeiro 21941-170, RJ, Brazil;
- National Cancer Institute, Pr. da Cruz Vermelha-23, Rio de Janeiro 20230-130, RJ, Brazil
| | | | - Elisangela Costa Lima
- Postgraduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho-373, Rio de Janeiro 21941-170, RJ, Brazil;
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Shakur AA, Ranjan RK, Sinha R, Hameed S, Mohan L. A Study of Drug Utilization Pattern and Pharmacoeconomic Analysis of Immunosuppressant Drugs in Patients With Skin Disorders in a Tertiary Care Hospital in Bihar. Cureus 2023; 15:e48541. [PMID: 37954626 PMCID: PMC10632555 DOI: 10.7759/cureus.48541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
Aims The cost-effective therapy of immunosuppressant drugs in dermatological conditions will not only lead to adherence to rational prescribing but will also increase patient compliance with fewer dropouts due to cost factor. Thus, this study was done to determine and compare the drug utilization pattern, prescribed daily dose/defined daily dose (PDD/DDD) defined by WHO, and the cost-effectiveness ratio of different immunosuppressants. Methods and material Prescriptions for patients with skin disorders prescribed with any one systematic or topical immunosuppressant were collected. The utilization of drugs in different skin disorders was expressed as frequency and percentage. PDD was compared with DDD as per the WHOCC-Anatomical Therapeutic Chemical (ATC)/DDD index. The pharmacoeconomic analysis was done using a cost-effectiveness ratio. Statistical analysis Descriptive statistics were used to calculate percentages, frequency, and 95% CI. The cost-effectiveness ratio in terms of SFDs (symptom-free days) was defined as the total cost of the initial antibiotic during the study period divided by the number of SFDs (cost/ SFD) and was expressed as mean±standard deviation, and the Kruskal-Wallis test was used to determine statistical significance of difference. Results Immunosuppressants were prescribed in 117 (19.12%) prescriptions out of a total of 612 prescriptions. Deflazacort was the most utilized systemic immunosuppressant prescribed in 27.18% of cases and was commonly prescribed for irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) followed by prednisolone and betamethasone. Tacrolimus was the most utilized topical immunosuppressant prescribed in 15.90% of patients and was commonly used for ICD and vitiligo followed by clobetasol and mometasone. Betamethasone, prednisolone, clobetasol, and mometasone had better cost-effectiveness. PDD/DDD of all immunosuppressants was less than one except prednisolone, which had a PDD/DDD ratio of 3.52. Conclusions The cost-effectiveness of steroids has the advantage of providing better patients' adherence to pharmacotherapy, but over-prescribing could also lead to long-term adverse effects of steroids. Pharmacovigilance research should also incorporate pharmacoeconomic analysis to determine the relation between these two aspects.
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Affiliation(s)
- Adil A Shakur
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Raushan K Ranjan
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Rajesh Sinha
- Department of Skin and Venereal Diseases, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Saajid Hameed
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Lalit Mohan
- Department of Pharmacology, Indira Gandhi Institute of Medical Sciences, Patna, IND
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Tanni KA, Qian J. Comparative safety of generic versus brand calcineurin inhibitors in solid organ transplant patients: a systematic review and meta-analysis. J Am Pharm Assoc (2003) 2023; 63:709-719. [PMID: 36863965 DOI: 10.1016/j.japh.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Although generic ciclosporin-A (CsA) and tacrolimus (TAC) have been used for the prophylaxis of organ rejection in transplant patients for decades, evidence in their safety profile compared to reference listed drugs (RLDs) in real-world transplant patients remains limited. OBJECTIVES To compare safety outcomes of generic CsA and TAC with the reference-listed drugs in solid organ transplant patients. METHODS We systematically searched MEDLINE, International Pharmaceutical Abstracts, PsycINFO, and Cumulative Index of Nursing and Allied Health Literature from inception until March 15, 2022, to select randomized and observational studies comparing safety profiles of generic versus brand CsA and TAC in de novo and/or stable solid organ transplant patients. Primary safety outcomes were changes in serum creatinine (Scr) and glomerular filtration rate (GFR). Secondary outcomes included incidences of infection, hypertension, diabetes, other serious adverse events (AEs), hospitalization, and death. Mean difference (MD) and relative risk (RR) with 95% confidence intervals (CIs) were calculated using random-effects meta-analyses. RESULTS Of 2612 publications identified, 32 studies met inclusion criteria. Seventeen studies had a moderate risk of bias. Scr was statistically significantly lower in patients using generic CsA compared to brand at 1 month (MD = -0.07; 95% CI: -0.11, -0.04), while there were no statistically significant differences at 4 months, 6 months, and 12 months. No differences were detected in Scr (MD = -0.04; 95% CI: -0.13, 0.04) and estimated GFR (MD = -2.06; 95% CI: -8.89, 4.77) between patients using generic and brand TAC at 6 months. No statistically significant differences between generic CsA and TAC with their RLDs were observed for secondary outcomes. CONCLUSION Findings support similarity in safety outcomes between generic and brand CsA and TAC in real-world solid organ transplant patients.
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Sharma K, Chandorkar AB, Kovil R, Venkataraman S, Subrahmanyam K, Mandal P, Wasir J, Abhyankar M, Prasad A, Sarda PS. Expert Opinion About the Pharmacoeconomic Edge of Low-Cost Dapagliflozin in Type 2 Diabetes Mellitus in Indian Clinical Settings. Cureus 2021; 13:e19194. [PMID: 34877189 PMCID: PMC8642133 DOI: 10.7759/cureus.19194] [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] [Accepted: 10/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to understand the attitudes, beliefs, and concerns of physicians across India regarding the economic burden of diabetes and subsequently the cost-effectiveness of low-cost dapagliflozin for the management of patients with uncontrolled type 2 diabetes mellitus (T2DM) on background metformin therapy in Indian clinical settings. Method A cross-sectional questionnaire survey was conducted among physicians treating people with T2DM with or without complications. The questions covered the general aspects of affordability and adherence to diabetes medications as well as specific details of low-cost dapagliflozin and its cost-effectiveness. Results In total, 844 physicians provided a response to the survey questionnaire. The physicians who participated in the study included diabetologists, endocrinologists, cardiologists, consulting physicians, and family physicians. A majority of the physicians (53%) opined that only 10%-30% of their patients can afford the cost of newer antidiabetic medicines, while 25% of the physicians mentioned that <10% of their patients had issues related to affordability. Further, 39% of the physicians opined that 20%-40% of their patients discontinue the medicines due to high cost. Most of the physicians (95%) agreed that due to the low cost of dapagliflozin, it can be used for the primary prevention of heart failure in patients with T2DM in India. Similarly, 98% of the physicians agreed that it can be used for the treatment of heart failure in patients with or without T2DM in India. A majority of these physicians (93%) responded that switching from expensive sodium/glucose cotransporter-2 inhibitors (SGLT2i) to low-cost dapagliflozin is a long-term cost-effective management of T2DM. In total, 98% of the physicians agreed that low-cost dapagliflozin has the characteristics of an ideal SGLT2i because of its metabolic benefits, cardioprotection, nephroprotection, and potential cost-effectiveness. Conclusion This survey-based study indicates that dapagliflozin is an effective and cost-saving therapy for patients with T2DM and complications. Low-cost dapagliflozin can revolutionize the treatment of T2DM in the Indian setting.
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Affiliation(s)
- Kamal Sharma
- Department of Cardiology, Dr. Kamal Sharma Cardiology Clinic, Ahmedabad, IND
| | | | - Rajiv Kovil
- Department of Diabetology and Endocrinology, Nanavati Super Specialty Hospital, Mumbai, IND
| | - S Venkataraman
- Department of Diabetology, Soorya Hospital, Chennai, IND
| | - Kav Subrahmanyam
- Department of Endocrinology, King George Hospital, Visakhapatnam, IND
| | | | - Jasjeet Wasir
- Department of Endocrinology, Medanta Hospital, Gurgaon, IND
| | | | - Ashish Prasad
- Scientific Services, USV Private Limited, Mumbai, IND
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Demir M, Akarsu EO, Dede HO, Bebek N, Yıldız SO, Baykan B, Akkan AG. Investigation of the Roles of New Antiepileptic Drugs and Serum BDNF Levels in Efficacy and Safety Monitoring and Quality of Life: A Clinical Research. ACTA ACUST UNITED AC 2021; 15:49-63. [PMID: 30864528 PMCID: PMC7497568 DOI: 10.2174/1574884714666190312145409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 12/11/2022]
Abstract
Objective: We aimed to determine the therapeutic drug monitoring (TDM) features and the relation to Brain-Derived Neurotrophic Factor (BDNF) of frequently used new antiepileptic drugs (NADs) including lamotrigine (LTG), oxcarbazepine (OXC), zonisamide (ZNS) and lacosamide (LCM). Moreover, we investigated their effect on the quality of life (QoL). Methods: Eighty epileptic patients who had been using the NADs, and thirteen healthy participants were included in this cross-sectional study. The participants were randomized into groups. The QOLIE-31 test was used for the assessment of QoL. We also prepared and applied “Safety Test”. HPLC method for TDM, and ELISA method for BDNF measurements were used consecutively. Results: In comparison to healthy participants, epileptic participants had lower marriage rate (p=0.049), education level (p˂0.001), alcohol use (p=0.002). BDNF levels were higher in patients with focal epilepsy (p=0.013) and in those with higher education level (p=0.016). There were negative correlations between serum BDNF levels and serum ZNS levels (p=0.042) with LTG-polytherapy, serum MHD levels (a 10-monohydroxy derivative of OXC, p=0.041) with OXC-monotherapy. There was no difference in BDNF according to monotherapy-polytherapy, drug-resistant groups, regarding seizure frequency. There was a positive correlation between total health status and QoL (p˂0.001). QOLIE-31 overall score (OS) was higher in those with OXC-monotherapy (76.5±14.5). OS (p˂0.001), seizure worry (SW, p=0.004), cognition (C, p˂0.001), social function (SF, p˂0.001) were different in the main groups. Forgetfulness was the most common unwanted effect. Conclusion: While TDM helps the clinician to use more effective and safe NADs, BDNF may assist in TDM for reaching the therapeutic target in epilepsy.
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Affiliation(s)
- Meral Demir
- Department of Medical and Clinical Pharmacology, Istanbul Faculty of Medicine, Istanbul University, Fatih / Capa 34093, Istanbul, Turkey.,Department of Medical and Clinical Pharmacology, Cerrahpasa Faculty of Medicine, Istanbul University, Cerrahpasa Street / Fatih 34093, Istanbul, Turkey
| | - Emel O Akarsu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih / Capa 34093, Istanbul, Turkey
| | - Hava O Dede
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih / Capa 34093, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih / Capa 34093, Istanbul, Turkey
| | - Sevda O Yıldız
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Fatih / Capa 34093, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Fatih / Capa 34093, Istanbul, Turkey
| | - Ahmet G Akkan
- Department of Medical and Clinical Pharmacology, Cerrahpasa Faculty of Medicine, Istanbul University, Cerrahpasa Street / Fatih 34093, Istanbul, Turkey
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Mersin S, Gedük A, Mehtap Ö, Tarkun P, Ünal S, Polat MG, Aygün K, Yenihayat EM, Albayrak H, Hacıhanifioğlu A. Evaluation of a Generic Bortezomib Molecule in Newly Diagnosed Multiple Myeloma Patients. Turk J Haematol 2021; 38:211-217. [PMID: 33947178 PMCID: PMC8386308 DOI: 10.4274/tjh.galenos.2021.2020.0555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective Constantly increasing health expenditures lead to the use of generic molecules and generic versions of bortezomib have been used for a long time. The aim of this study is to retrospectively examine the effectiveness, side effects, and reliability of generic bortezomib in newly diagnosed multiple myeloma (MM) patients. Materials and Methods The data of 95 patients who received four cycles of bortezomib as first- or second-line therapy in a single center were retrospectively recorded. Treatment responses, side effects, and progression-free survival (PFS) rates were calculated and compared. Results Of the 95 patients, 42 used the original and 53 used the generic molecule. Epidemiological data, MM types, genetic risk groups, laboratory values at diagnosis, and bortezomib treatment lines (as a first line or second) were evaluated and there was no statistical difference between the two groups. When the response rates were evaluated according to International Myeloma Working Group criteria, there was no significant difference (p=0.42). Rates of partial response and higher responses were similar (81% vs. 79.2%, p=0.84). PFS rates were 42.8 months with the original and 37.8 months with the generic molecule (p=0.68). Side effects were seen in 44.2% of all patients, and the most common side effects were neuropathy, cytopenia, and infection. These rates were similar in the two groups (p=0.55). Conclusion Although this retrospective study is limited in scope, it is the first study comparing the original molecule of bortezomib with a generic version. There were no statistical differences between the two groups in terms of treatment responses, PFS, or side effects. However, large-scale evaluations will help obtain more data on this subject.
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Affiliation(s)
- Sinan Mersin
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Ayfer Gedük
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Özgür Mehtap
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Pınar Tarkun
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Serkan Ünal
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Merve Gökçen Polat
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Kemal Aygün
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Emel Merve Yenihayat
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Hayrunnisa Albayrak
- Kocaeli University Faculty of Medicine, Department of Hematology, Kocaeli, Turkey
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Alderfer J, Hansen RA, Mattingly TJ. Understanding authorized generics-A review of the published clinical data. J Clin Pharm Ther 2021; 46:1489-1497. [PMID: 33829528 DOI: 10.1111/jcpt.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Despite the large body of evidence demonstrating equivalent efficacy and safety for branded drugs and their generic counterparts, some patients and providers have the perception that generics may be less safe and effective than branded agents. Authorized generics (AGs) are a category of generic drugs defined by the United States Food and Drug Administration (FDA) as being the same as the brand-name drug without the brand's name on the label and which may have minor differences, such as tablet or capsule markings for identification. Studies in which AGs are considered along with other generics may increase our understanding of factors that may influence perceptions about generics and shed light on areas where education may be impactful. The objectives of this paper are to provide information about AGs, review studies in which they have been evaluated and explore the role that AGs may fill in the individualized treatment of patients. METHODS A literature review was conducted on 30 September 2019 with follow-up search on 4 March 2020. The search was focussed on published papers and meeting abstracts that provided information on AGs with respect to medical and health outcomes of therapy as well as switching in individuals receiving branded, AG, or other generic agents. Information about patients' perceptions of generic medications and adherence to therapy was also included. Additional information, including relevant government sources, such as the FDA website and the Federal Trade Commission Report, was included as appropriate. RESULTS The literature specific to AGs is limited, but available data clearly highlight the importance of patient perception of generics as well as medication appearance as factors that may affect adherence and potentially more frequent switchbacks to branded agents from generics or AGs. WHAT IS NEW AND CONCLUSION To our knowledge, this is the first narrative review to provide a summary of the published evidence about AGs with respect to clinical and health outcomes and switching. There is a need for more research and education regarding the use of AGs in clinical practice if they are to become more recognized as a potential treatment choice for patients. Generic medications play an important role in the healthcare system, and AGs may be able to provide an option to meet the specific needs of individual patients.
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Affiliation(s)
| | | | - T Joseph Mattingly
- Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Arafat M, Fahelelbom KM, Sarfraz MK, Bostanudin MF, Sharif QUA, Esmaeil A, Al Hanbali OA, Aburuz S. Comparison between Branded and Generic Furosemide 40 mg Tablets Using Thermal Gravimetric Analysis and Fourier Transform Infrared Spectroscopy. J Pharm Bioallied Sci 2020; 12:489-498. [PMID: 33679098 PMCID: PMC7909057 DOI: 10.4103/jpbs.jpbs_365_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 01/06/2023] Open
Abstract
Background and Purpose There has been a long-standing belief that generic drugs are of lower value in comparison to their branded name counterparts. They are in particular under scrutiny due to their low market price. Even though the reduction in costs is largely based on skipping expensive preclinical studies and clinical trials for generic drugs, the purity and quality of the raw materials in the production of generic drugs is debatable. Thus, the objective of the study was to analyze and assess the quality comparability of generic furosemide 40 mg (FSD) tablets to branded product available in the market. Materials and Methods Quality control tests, in vitro drug release assessments, and thermal analysis investigations for both analog products of FSD were performed. Various physical parameters related to the tablet quality, such as hardness, weight variation, and friability tests, were examined. In vitro drug release behavior evaluations were conducted according to United States Pharmacopeia (USP) specifications and guidelines, whereas thermal analysis was carried out using thermal gravimetric analysis (TGA), and tablets were further evaluated by Fourier transform infrared (FTIR) spectroscopy. Results The results indicated a significant variation between the two products in terms of hardness, weight variation, and friability. This could be correlated to variation appeared in thermal and spectroscopic spectra between the two products using TGA and FTIR. Drug release of FSD was slightly different between both products following incubation in different pH media (1.2, 3.0, and 6.5; 120 min), however, this was in accordance with USP dissolution requirements as < 80% of drug release was obtained within the first 30 min from each product. Conclusion This study is a useful example for the independent investigations using thermal and spectroscopic analysis to confirm potential hidden variations between generic and branded products that could not be obtained by the bioequivalence studies.
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Affiliation(s)
- Mosab Arafat
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE
| | | | | | | | | | - Anna Esmaeil
- College of Pharmacy, Al Ain University, Al Ain, Abu Dhabi, UAE
| | | | - Salahdein Aburuz
- College of Medicine and Health Sciences, The United Arab Emirates University, Al Ain, UAE.,Faculty of Pharmacy, University of Jordan, Amman, Jordan
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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: 0.2] [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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Das P, Jana B, Dhar K, Goel G, Bhattacharya S, Chandy M. Relative potency of different generic brands of meropenem, colistin and fosfomycin: Implications for antimicrobial therapy and antimicrobial formulary. Indian J Med Microbiol 2019; 37:95-98. [PMID: 31424016 DOI: 10.4103/ijmm.ijmm_18_248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is a need of a relatively simple and inexpensive method for the determination of relative potency of various generic brands of antibiotics in comparison to original products. The current study describes an agar diffusion method which can be performed in any microbiology laboratory, is cheap (costs $2 per test) and its results can be available after overnight incubation. The results show that neither all generics are reliable nor are all generic antibiotics of poor quality.
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Affiliation(s)
- Parijat Das
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Bishwaranjan Jana
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Kingshuk Dhar
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Gaurav Goel
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center, Kolkata, West Bengal, India
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11
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Izadi E, Afshan G, Patel RP, Rao VM, Liew KB, Meor Mohd Affandi MMR, Kifli N, Suleiman A, Lee KS, Sarker MMR, Zaidi ST, Ming LC. Levofloxacin: Insights Into Antibiotic Resistance and Product Quality. Front Pharmacol 2019; 10:881. [PMID: 31474853 PMCID: PMC6702332 DOI: 10.3389/fphar.2019.00881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/15/2019] [Indexed: 01/10/2023] Open
Abstract
Counterfeit and substandard medicines are recognized as one of serious threats to public health. The product quality of antibacterial medicine will compromise patients’ recovery and increase the chance of antibacterial resistance. The review aims to provide a summary of low quality levofloxacin issues and the risk factors as well as suggesting the aspects of product quality that need to be regulated strictly. Quality of the active ingredient, levofloxacin, has an important role to contribute to successful therapy. The poor quality of raw material, directly and indirectly, causes treatment failure as the presence of insufficient dose, mislabeled content, and poor dissolution characteristics can lead to lower bioavailability. Identifying and reporting these factors can potentially help in improving the quality of drug marketed in various developing countries and may also reduce the incidences of treatment failure. Dissolution test is used for testing the dissolution profiles and the rate of drug release from solid formulation such as oral formulations, thus providing information regarding the in vivo performance of a formulation and its bioequivalence. On the other hand, quality-testing procedures are used for comparing the quality of products.
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Affiliation(s)
- Ensieh Izadi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gull Afshan
- Department of Pulmonary Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Rahul P Patel
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | - Kai Bin Liew
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | | | - Nurolaini Kifli
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
| | - Amal Suleiman
- College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Kah Seng Lee
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | | | - Syed Tabish Zaidi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia.,School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Long Chiau Ming
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia.,PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
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Abdullah AH, Holtorf AP, Al-Hussaini M, Lemay J, Alowayesh M, Kaló Z. Stakeholder driven development of a multi-criteria decision analysis tool for purchasing off-patent pharmaceuticals in Kuwait. J Pharm Policy Pract 2019; 12:9. [PMID: 31011430 PMCID: PMC6466779 DOI: 10.1186/s40545-019-0171-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/22/2019] [Indexed: 12/01/2022] Open
Abstract
Background In Kuwait, the government is planning to improve the specifications for purchase of medicine and to improve the tendering system intending to slow the growth of the expenditure for medicine and to improve the sustainability of the healthcare system. Multiple Criteria Decision Analysis (MCDA) is a method which can help to assess multiple and sometimes conflicting criteria in the evaluation of the available alternatives. The objective of this initiative was to develop collaboratively a MCDA tool which is locally relevant, and which could be used to improve the use of performance indicators in the purchasing of off-patent pharmaceuticals. Methods Nineteen leading experts representing a broad range of pharmaceutical policy stakeholders elaborated a locally adapted MCDA format by following a 7-step process for criteria selection, scoring, ranking and weighting. Results The most important criterion was the price measured as savings versus the originator product with a weight of 35% in the final decision and a full score with a 60% price reduction. In addition, eight criteria were considered important for assessing the product performance in the Kuwaiti healthcare system: ‘equivalence with the reference product’ (weight of 16.2%), ‘stability and drug formulation’ (13.5%), ‘quality assurance’ (11.2%), ‘reliability of drug supply’ (8.8%), ‘macroeconomic benefit’ (5.5%), ‘real world outcomes (clinical and economic)’ (4.2%), ‘pharmacovigilance’ (3.3%), and ‘added value services related to the product’ (2.3%). Conclusions A MCDA model was successfully adapted to the Kuwait decision context by a group of Kuwaiti pharmacists from a broad range of institutions. The participants agreed with the approach and considered it suitable to improve the transparency and consistency of decision making for off-patent pharmaceuticals in Kuwait. A pilot implementation project was proposed.
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Affiliation(s)
| | - Anke-Peggy Holtorf
- Health Outcomes Strategies GmbH, Colmarerstrasse 58, 4055 Basel, CH Switzerland
| | - Maryam Al-Hussaini
- 3Department of Pharmaceutical Sciences, College of Health Sciences, Public Authority for Applied Education and Training PAAET, Kuwait City, Kuwait
| | - Jacinthe Lemay
- 4Department of Pharmacology and Applied Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Maryam Alowayesh
- 5Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait City, Kuwait
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,7Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
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Khosravi A, Salimi B, Esfahani-Monfared Z, Seifi S, Mirtavoos-Mahyari H. A Phase IV Efficacy Study of Formeta Plus Carboplatin as First-Line Treatment of Advanced Non-Squamous, Non-Small
Cell Lung Cancer in Iran: An Affordable Price with Clinical Benefit. Asian Pac J Cancer Prev 2018; 19:2973-2978. [PMID: 30362335 PMCID: PMC6291026 DOI: 10.22034/apjcp.2018.19.10.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: This study performed to assess the efficacy and safety of Formeta (generic form of Pemetrexed) plus Carboplatin as first-line chemotherapy in advanced stage, non- squamous, non small cell lung cancer (NSCLC) in Iran. Methods: This was a post marketing single-arm phase IV efficacy study of Formeta (manufactured by Oncomed., Czech Republic) and Carboplatin in chemo-naive advanced non-squamous NSCLC Iranian patients. Patients received up to six cycles of Formeta (500 mg/m2) combined with Carboplatin (area under the curve: AUC 5) every 3 weeks. The primary endpoint was the progression free survival (PFS) and secondary endpoints were safety and overall survival (OS). Results: Fifty-two patients were enrolled between June 2014 to January 2016, and 44 patients were evaluable for both safety and efficacy. Partial and complete responses were achieved in 19 (36.5 %) and 2 (3.8%) patients, respectively as well as stable disease in 8 patients (15.3 %). Median of PFS and OS were 7.9 ± 1.1 months and 12.43±0.6 months, respectively. Anemia was the most prevalent adverse events of this regimen. Grades 3 or 4 of adverse events were not observed in any patients. Non-hematologic and other grades of hematologic toxicities were generally mild, and there were no treatment-related deaths. Conclusion: The combination of Formeta and Carboplatin was effective in advanced non-squamous NSCLC and can be a suitable candidate as first-line treatment in these patient’s population.
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Affiliation(s)
- Adnan Khosravi
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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14
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Hashemi-Meshkini A, Zekri HS, Karimi-Yazdi H, Zaboli P, Sahraian MA, Nikfar S. Pegylated versus non-pegylated interferon beta 1a in patients with relapsing-remitting multiple sclerosis: A cost-effectiveness analysis. IRANIAN JOURNAL OF NEUROLOGY 2018; 17:123-128. [PMID: 30886679 PMCID: PMC6420694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Pegylated (PEG) interferon beta 1a has been approved by the United States Food and Drug Administration (USFDA) as an alternative to interferon beta 1a for multiple sclerosis (MS). Due to its higher price, this study aimed to evaluate the cost-effectiveness of PEG-interferon beta 1-a compared with interferon beta 1a from an Iranian payer perspective. Methods: A Markov model was designed according to health states based on Expanded Disability Status Scale (EDSS) and one-month cycles over a 10-year time horizon. Direct medical and non-medical costs were included from a payer perspective. Results: The incremental cost-effectiveness ratio (ICER) was estimated around 11111 US dollars (USD) per quality-adjusted life-year (QALY) gained for the PEG-interferon versus interferon regimen [with currency rate of 29,000 Iranian Rial (IRR) to 1 USD in 2016]. Conclusion: Considering the cost-effectiveness threshold in Iran [three times of gross domestic product (GDP) per capita or 15,945 USD], PEG-interferon beta 1-a could be considered as a cost effective treatment for Iranian patients with MS.
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Affiliation(s)
- Amir Hashemi-Meshkini
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hedieh Sadat Zekri
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Pardis Zaboli
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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15
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Gini Index-Based Maximum Concentration and Area Under the Curve Split Points for Analysing Adverse Event Occurrence in Bioequivalence Studies. Pharmaceut Med 2018. [DOI: 10.1007/s40290-017-0217-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Oluboka OJ, Katzman MA, Habert J, McIntosh D, MacQueen GM, Milev RV, McIntyre RS, Blier P. Functional Recovery in Major Depressive Disorder: Providing Early Optimal Treatment for the Individual Patient. Int J Neuropsychopharmacol 2017; 21:128-144. [PMID: 29024974 PMCID: PMC5793729 DOI: 10.1093/ijnp/pyx081] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Major depressive disorder is an often chronic and recurring illness. Left untreated, major depressive disorder may result in progressive alterations in brain morphometry and circuit function. Recent findings, however, suggest that pharmacotherapy may halt and possibly reverse those effects. These findings, together with evidence that a delay in treatment is associated with poorer clinical outcomes, underscore the urgency of rapidly treating depression to full recovery. Early optimized treatment, using measurement-based care and customizing treatment to the individual patient, may afford the best possible outcomes for each patient. The aim of this article is to present recommendations for using a patient-centered approach to rapidly provide optimal pharmacological treatment to patients with major depressive disorder. Offering major depressive disorder treatment determined by individual patient characteristics (e.g., predominant symptoms, medical history, comorbidities), patient preferences and expectations, and, critically, their own definition of wellness provides the best opportunity for full functional recovery.
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Affiliation(s)
- Oloruntoba J Oluboka
- Department of Psychiatry, University of Calgary, Alberta, Canada,Correspondence: Oloruntoba J. Oluboka, MD, Director, PES/PORT, Consultant Psychiatrist, Addiction and Mental Health, South Health Campus, Alberta Health Services, Assistant Clinical Professor of Psychiatry, University of Calgary, Calgary, Canada ()
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, Ontario, Canada
| | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenda M MacQueen
- Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Roumen V Milev
- Department of Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Ontario, Canada
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario
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17
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Faqeer NA, Nazer L. Generic and Branded Docetaxel. J Clin Pharmacol 2017; 57:936. [DOI: 10.1002/jcph.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Nour Al Faqeer
- Department of Pharmacy; King Hussein Cancer Center; Amman Jordan
| | - Lama Nazer
- Department of Pharmacy; King Hussein Cancer Center; Amman Jordan
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18
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Marimuthu SP, Iyer G, Segal JB, Singh S. Patient-relevant outcomes associated with generic tamsulosin, levothyroxine and amphetamine in the FDA Adverse Event Reporting System: a pilot study. J Comp Eff Res 2017; 6:437-447. [DOI: 10.2217/cer-2017-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Patient-reported outcomes associated with adverse events (AEs) reported with generics have not been evaluated. To map AEs associated with generics to the NIH Patient-reported Outcomes Measurement Information System. Methods: We mapped 381 AEs from 148 case reports of generic tamsulosin, levothyroxine and amphetamine/dextroamphetamine to the physical, mental and social domain of the NIH Patient-Reported Outcomes Measurement Information System after reviewing 1237 case reports in the US FDA's Adverse Event Reporting System (FAERS; 2011–2013). Results: 75%, 76% and 71% reports were classified under the physical domain for tamsulosin, levothyroxine and amphetamine/dextroamphetamine, while 9%, 9% and 18% reports were classified under the mental domain, respectively. Conclusion: FAERS reveals several domains of patient-relevant concerns associated with generic drugs.
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Affiliation(s)
- Sathiya Priya Marimuthu
- Center for Drug Safety & Effectiveness, Johns Hopkins Bloomberg School of Public Health, MD 21205, USA
- Division of Clinical Pharmacology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Geetha Iyer
- Doctoral Student in Population Health Sciences, Harvard University, Boston, MA 02115, USA
| | - Jodi B Segal
- Center for Drug Safety & Effectiveness, Johns Hopkins Bloomberg School of Public Health, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, MD 21205, USA
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, MD 21287, USA
| | - Sonal Singh
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Reddy NHS, Patnala S, Kanfer I. Investigation of Biowaivers for Immediate Release Formulations Containing BCS III Drugs, Acyclovir, Atenolol, and Ciprofloxacin Hydrochloride, Using Dissolution Testing. AAPS PharmSciTech 2017; 18:424-431. [PMID: 27038483 DOI: 10.1208/s12249-016-0520-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/20/2016] [Indexed: 11/30/2022] Open
Abstract
The dissolution of several products containing Biopharmaceutical Classification System (BCS) class III drugs, acyclovir, atenolol, and ciprofloxacin hydrochloride, listed in the WHO essential drug list (EDL), was tested and compared with their respective comparator pharmaceutical products (CPPs) marketed in South Africa and India. US Pharmacopeia (USP) buffers of pH 1.2, 4.5, and 6.8 were used as dissolution media and tested using USP apparatus 2 at 75 rpm and 900 ml. Nine acyclovir products were tested, and only three dissolved very rapidly in all media; i.e., they showed a release of >85% in 15 min. Eight atenolol products tested were all very rapidly dissolving in all three pH media. Ten ciprofloxacin hydrochloride products were tested, and the results showed that only five products met the WHO biowaiver criteria. This study indicates that not all marketed products containing the same BCS III active pharmaceutical ingredient (API) in similar strength and dosage form are necessarily in vitro equivalent as per the WHO biowaiver criteria. Furthermore, selection and availability of an innovator product as CPP are important considerations that can affect the outcomes of such studies.
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20
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Novaretti MCZ, Aquino S. Challenges in Improving Access to Generic Drugs in Brazil. JOURNAL OF HEALTH MANAGEMENT 2016. [DOI: 10.1177/0972063416666343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pharmaceutical care is essential for the control and treatment of numerous diseases, nevertheless it is estimated that over 25% of world population do not have access to essential medicines. In this scenario, generics plays a key role in providing lower cost medicines worldwide. In Brazil, generic drugs do not prevail in the pharmaceutical market although the Federal government certifies their quality and the price is lower when compared to reference products. This paper addresses a thorough understanding of this situation can make available data for decision-making, assisting health care managers, the pharmaceutical industry and pharmacies to improve the pharmaceutical care in the country.
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Affiliation(s)
| | - Simone Aquino
- PhD, Professor of Health Administration Graduate Program, Nove de Julho University, Brazil
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21
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Faqeer NA, Mashni O, Dawoud R, Rumman A, Hanoun E, Nazer L. Comparing the Incidence of Febrile Neutropenia Resulting in Hospital Admission Between the Branded Docetaxel and the Generic Formulations. J Clin Pharmacol 2016; 57:275-279. [PMID: 27479828 DOI: 10.1002/jcph.803] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022]
Abstract
Studies have raised concern about the safety of generic compared with branded drugs. Febrile neutropenia (FN) resulting in hospital admission was compared between the branded docetaxel (Taxotere®, Sanofi) and 2 generic formulations (docetaxel Ebewe and docetaxel Hospira) in patients with breast cancer. This was a retrospective study that included patients with breast cancer who received docetaxel between January 2012 and December 2014. Patients who had an admission diagnosis of FN and had received docetaxel within 14 days prior to admission were evaluated. The docetaxel brand and dose, patient characteristics, hospital length of stay, admission to the intensive care unit (ICU), and mortality were recorded. During the study period, 2904 cycles of docetaxel were given for 876 patients (1519 cycles of docetaxel Sanofi, 811 cycles of docetaxel Hospira, and 574 cycles of docetaxel Ebewe). Among the cycles given, 130 cycles were associated with FN that required hospital admission. The overall incidence of FN resulting in hospital admission was significantly higher in patients who had received docetaxel Hospira, compared with patients who had received docetaxel Sanofi (47[5.8%] cycles vs 53 [3.5%] cycles, P = .009), but there was no significant difference between docetaxel Ebewe and docetaxel Sanofi (30[5.2%] cycles vs 53 [3.5%] cycles, P = .069). All cases of FN resolved except for 1 patient who died in the ICU after receiving docetaxel Ebewe. There was a significant difference in the incidence of FN between docetaxel Sanofi and docetaxel Hospira, but all cases in both groups resolved completely.
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Affiliation(s)
- Nour Al Faqeer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Ola Mashni
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Rawan Dawoud
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Asma Rumman
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Esraa Hanoun
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
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22
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Flacco ME, Manzoli L, Boccia S, Puggina A, Rosso A, Marzuillo C, Scaioli G, Gualano MR, Ricciardi W, Villari P, Ioannidis JPA. Registered Randomized Trials Comparing Generic and Brand-Name Drugs: A Survey. Mayo Clin Proc 2016; 91:1021-34. [PMID: 27402583 DOI: 10.1016/j.mayocp.2016.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/25/2016] [Accepted: 04/28/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the research agenda of registered randomized trials comparing generic and brand-name drugs in terms of who sponsors them, whether they are published promptly, and whether they find favorable results. METHODS We included randomized trials comparing the safety or efficacy of brand-name vs generic medications that were registered in ClinicalTrials.gov or other registries from January 1, 2000, through July 31, 2015. To identify published articles or results generated from such trials, we searched PubMed, Scopus, Google, and registry databases. Data were compared across sponsorship categories ("inbred" if the compared drugs were owned by the same company or its partners/subsidiaries, "competitive" if the compared drugs were owned by competing companies, and "apparently nonprofit"), and time to publication was evaluated with Cox analysis. RESULTS We found 207 registered protocols reporting on 186 completed trials. Among those trials, 37 had published their results and another 56 had posted results in registries, for a total of 93 trials with available results. Four years after trial completion, results were available for 64 of 138 trials (46.4%), with substantial differences by sponsor: 70.8% (34 of 48), 28.1% (18 of 64), and 46.2% (12 of 26) of the inbred, competitive, and nonprofit trials, respectively. In multivariate modeling, inbred trials had a 1.73-fold risk of having results available compared with competitive trials (P=.04). Almost all trials reported favorable results, with the exception of 4 (4.3% of the 93 trials with results). CONCLUSION Despite the importance of generic drugs, relatively few registered randomized trials have compared the health effects of generic vs brand-name medicines, and there is an associated unsatisfactory publication rate and almost ubiquitous favorable results. The overall literature on the topic is at high risk of bias, possibly in favor of generic drugs. Higher nonprofit funding and stronger pressure to register trials and publish results are needed.
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Affiliation(s)
- Maria Elena Flacco
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; Regional Healthcare Agency of the Abruzzo Region, Pescara, Italy; Local Health Unit of Pescara, Pescara, Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences, University of Chieti, Chieti, Italy; Regional Healthcare Agency of the Abruzzo Region, Pescara, Italy; Local Health Unit of Pescara, Pescara, Italy.
| | - Stefania Boccia
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Anna Puggina
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | | | - Walter Ricciardi
- Institute of Public Health, Catholic University of Sacred Heart, Rome, Italy; Italian National Institute of Health, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA; Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA
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Fallu A, Dabouz F, Furtado M, Anand L, Katzman MA. A randomized, double-blind, cross-over, phase IV trial of oros-methylphenidate (CONCERTA(®)) and generic novo-methylphenidate ER-C (NOVO-generic). Ther Adv Psychopharmacol 2016; 6:237-51. [PMID: 27536342 PMCID: PMC4971598 DOI: 10.1177/2045125316643674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder with onset during childhood. Multiple aspects of a child's development are hindered, in both home and school settings, with negative impacts on social, emotional, and cognitive functioning. If left untreated, ADHD is commonly associated with poor academic achievement and low occupational status, as well as increased risk of substance abuse and delinquency. The objective of this study was to evaluate adult ADHD subject reported outcomes when switched from a stable dose of CONCERTA(®) to the same dose of generic Novo-methylphenidate ER-C(®). METHODS Randomized, double-blind, cross-over, phase IV trial consisted of two phases in which participants with a primary diagnosis of ADHD were randomized in a 1:1 ratio to 3 weeks of treatment with CONCERTA or generic Novo-Methylphenidate ER-C. Following 3 weeks of treatment, participants were crossed-over to receive the other treatment for an additional 3 weeks. Primary efficacy was assessed through the use of the Treatment Satisfaction Questionnaire for Medication, Version II (TSQM-II). RESULTS Participants with ADHD treated with CONCERTA were more satisfied in terms of efficacy and side effects compared to those receiving an equivalent dose of generic Novo-Methylphenidate ER-C. All participants chose to continue with CONCERTA treatment at the conclusion of the study. CONCLUSION Although CONCERTA and generic Novo-Methylphenidate ER-C have been deemed bioequivalent, however the present findings demonstrate clinically and statistically significant differences between generic and branded CONCERTA. Further investigation of these differences is warranted.
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Affiliation(s)
- Angelo Fallu
- Clinique Woodward, 717, rue Woodward, DIEX Research Inc., Sherbrooke, QC, J1G 1W4, Canada
| | - Farida Dabouz
- FB2D Clinical Research Consulting, Montréal, Québec, Canada
| | - Melissa Furtado
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Leena Anand
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
| | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada
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Gallelli L, Maida F, Staltari O, Rende P, Russo E, Caroleo B, De Sarro G. Recurrence of atrial fibrillation after switching from brand to generic atenolol. J Pharmacol Pharmacother 2015; 6:39-41. [PMID: 25709353 PMCID: PMC4319249 DOI: 10.4103/0976-500x.149146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/31/2014] [Accepted: 06/28/2014] [Indexed: 11/04/2022] Open
Abstract
Beta blockers are the initial treatment for rate control of supraventricular tachyarrhythmia in patients without a history of myocardial infarction or left ventricular dysfunction. In this article we report the recurrence of atrial fibrillation after switching to the generic formulation of atenolol.
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Affiliation(s)
- Luca Gallelli
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Francesca Maida
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Orietta Staltari
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Pierandrea Rende
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Benedetto Caroleo
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
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25
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Serra R, Grande R, Buffone G, Scarcello E, Tripodi F, Rende P, Gallelli L, de Franciscis S. Effects of glucocorticoids and tumor necrosis factor-alpha inhibitors on both clinical and molecular parameters in patients with Takayasu arteritis. J Pharmacol Pharmacother 2014; 5:193-6. [PMID: 25210399 PMCID: PMC4156830 DOI: 10.4103/0976-500x.136101] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 02/08/2014] [Accepted: 02/15/2014] [Indexed: 12/20/2022] Open
Abstract
Objective: To explore the effect of sequential treatment with glucocorticoid and tumor necrosis factor-alpha inhibitors in patients with Takayasu arteritis (TA). Materials and Methods: In five patients with TA, the effects of the sequential treatment with prednisone for 5-7 months and then with adalimumab (ADA) + methotrexate (MTX) or infliximab + MTX, or with ADA only, for 12 months on both clinical and laboratory findings were evaluated. Results: All treatments improved both symptoms and laboratory parameters without the development of side-effects. Conclusions: It was hypothesized that MMP-9 and neutrophil gelatinase-associated lipocalin could be markers of the response to the treatments.
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Affiliation(s)
- Raffaele Serra
- Department of Medical and Surgical Science, Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
| | - Raffaele Grande
- Department of Medical and Surgical Science, Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
| | - Gianluca Buffone
- Department of Medical and Surgical Science, Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
| | - Edoardo Scarcello
- Department of Surgery, Unit of Vascular Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Fabio Tripodi
- Department of Pharmacological, Biological and Chemical Science, University of Parma, Parma, Italy
| | - Pierandrea Rende
- Department of Health Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Gallelli
- Department of Health Science, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stefano de Franciscis
- Department of Medical and Surgical Science, Interuniversity Center of Phlebolymphology, International Research and Educational Program in Clinical and Experimental Biotechnology, Catanzaro, Italy
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