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Espona M, Echeverria-Esnal D, Hernandez S, Almendral A, Gómez-Zorrilla S, Limon E, Ferrandez O, Grau S. Impact of Generic Entry on Hospital Antimicrobial Use: A Retrospective Quasi-Experimental Interrupted Time Series Analysis. Antibiotics (Basel) 2021; 10:antibiotics10101149. [PMID: 34680730 PMCID: PMC8532699 DOI: 10.3390/antibiotics10101149] [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: 08/09/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The impact of antimicrobials generic entry (GE) is controversial. Their introduction could provide an economic benefit yet may also increase their consumption, leading to a higher risk of resistance. Our aim was to analyze the impact of GE on trends of antimicrobial consumption in an acute-care hospital. Methods: A retrospective quasi-experimental interrupted time series analysis was conducted at a 400-bed tertiary hospital in Barcelona, Spain. All antimicrobials for systemic use for which a generic product entered the hospital from January 2000 to December 2019 were included. Antimicrobial consumption was expressed as DDD/100 bed days. Results: After GE, the consumption of cefotaxime (0.09, p < 0.001), meropenem (0.54, p < 0.001), and piperacillin-tazobactam (0.13, p < 0.001) increased, whereas the use of clindamycin (−0.03, p < 0.001) and itraconazole (−0.02, p = 0.01) was reduced. An alarming rise in cefepime (0.004), daptomycin (1.02), and cloxacillin (0.05) prescriptions was observed, despite not achieving statistical significance. On the contrary, the use of amoxicillin (−0.07), ampicillin (−0.02), cefixime (−0.06), fluconazole (−0.13), imipenem–cilastatin (−0.50) and levofloxacin (−0.35) decreased. These effects were noticed beyond the first year post GE. Conclusions: GE led to an increase in the consumption of broad-spectrum molecules. The potential economic benefit of generic antibiotics could be diluted by an increase in resistance. Antimicrobial stewardship should continue to monitor these molecules despite GE.
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Affiliation(s)
- Mercè Espona
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Daniel Echeverria-Esnal
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Sergi Hernandez
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08097 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Alexander Almendral
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08097 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Silvia Gómez-Zorrilla
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Department of Infectious Diseases, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain
| | - Enric Limon
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08097 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Olivia Ferrandez
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Department of Pharmacology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-483-151
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Yang P, Fujimura S, Du Y, Zhang B, Yang L, Kawamura M, Zhang Z, Zhai S. Comparison of Pharmaceutical Characteristics between Brand-Name Meropenem and Its Generics. Antibiotics (Basel) 2021; 10:antibiotics10091096. [PMID: 34572677 PMCID: PMC8469160 DOI: 10.3390/antibiotics10091096] [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: 08/12/2021] [Revised: 09/04/2021] [Accepted: 09/08/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to provide comparative information of pharmaceutical properties, including particle morphology and distribution uniformity, solubility, presence of residual solvent and insoluble particles, and antimicrobial activities, between brand-name meropenem (Mepem®, BNM) and its six generic products (GPs A-F) marketed in China. Particles of GP-A and -C in dry powder had similar diameters of BNM, while other GPs were larger. Only BNM and GP-A were completely dissolved within 100 s in the lab condition. No insoluble particles >25 μm in diameter were detected in BNM and GP-E. Regarding stability of GPs solutions evaluated by concentration of open-ring metabolites at 6 h and 8 h, BNM showed the lowest open-ringed metabolite concentrates. Residual solvent of acetone detected in one GP showed the maximum value, while ethanol and ethyl acetate were detected both in product E and product F. The concordance rates (%) of minimum inhibitory concentration (MIC) of each generic compared to BNM were 89.5, 85, 87.5, 88, 88.5, and 86.5, respectively, although no significant difference was reached in MIC. Pharmaceutical characteristic differences between the BNM and GPs identified in this study could provide insights into understanding the deviations in the drug manufacturing processes of generic drugs.
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Affiliation(s)
- Ping Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Y.); (Y.D.); (B.Z.); (L.Y.)
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases & Chemotherapy, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan;
- Correspondence: (S.F.); (S.Z.)
| | - Yawei Du
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Y.); (Y.D.); (B.Z.); (L.Y.)
| | - Bei Zhang
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Y.); (Y.D.); (B.Z.); (L.Y.)
| | - Li Yang
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Y.); (Y.D.); (B.Z.); (L.Y.)
| | - Masato Kawamura
- Division of Clinical Infectious Diseases & Chemotherapy, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan;
| | - Zhenhua Zhang
- Department of Medical Affairs, Sumitomo Pharmaceuticals (Suzhou) Co. Ltd., Shanghai 200025, China;
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; (P.Y.); (Y.D.); (B.Z.); (L.Y.)
- Correspondence: (S.F.); (S.Z.)
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Molinier A, Palmaro A, Rousseau V, Sommet A, Bourrel R, Montastruc JL, Bagheri H. Does substitution of brand name medications by generics differ between pharmacotherapeutic classes? A population-based cohort study in France. Eur J Clin Pharmacol 2016; 73:471-477. [PMID: 28035437 DOI: 10.1007/s00228-016-2185-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to measure the rate of substitution failure to generic antiepileptic drugs (AEDs) compared to two other pharmacotherapeutic classes (neuroleptics, beta-blockers). METHODS We conducted a cohort study involving beneficiaries of the French health insurance system from January 2009 to November 2012. Substitution failure to generic drugs was estimated by the rate of switchback (i.e. from generic drug back to its branded drug). We selected the patients who had a dispensation of a branded AED for 60 days or more during the 90 days preceding the generic substitution. Cox proportional hazard regression was used to model time to switchback for antiepileptics vs. other therapeutic classes in the 90 days after generic substitution, adjusting for age, gender and polytherapy. RESULTS The cohort included 6727 patients of whom 1947 were exposed to AEDs, 2398 to neuroleptics and 2382 to beta-blockers. The switchback rate was 62% for AEDs. AED users were more likely to switch back as compared to beta-blocker (crude hazard ratio 1.87; 95% CI 1.68-2.07 for patients under 75) or neuroleptic users. The same observation was made in patients above 75 years (crude hazard ratio 1.36; 95% CI 1.16-1.60). CONCLUSIONS Compared to beta-blocker users, AED users were more likely to switch back to the branded drug, whereas this difference was not observed with neuroleptics. These results could reflect a poor acceptance of switching AEDs to generic compounds in France.
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Affiliation(s)
- Alicia Molinier
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France
| | - Aurore Palmaro
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France. .,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France. .,CIC INSERM 1436 Université et Centre Hospitalier Universitaire de Toulouse, Toulouse , France.
| | - Vanessa Rousseau
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,CIC INSERM 1436 Université et Centre Hospitalier Universitaire de Toulouse, Toulouse , France.,Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Agnès Sommet
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,CIC INSERM 1436 Université et Centre Hospitalier Universitaire de Toulouse, Toulouse , France
| | - Robert Bourrel
- Direction Régionale du Service du contrôle Médical de Midi-Pyrénées, Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Haleh Bagheri
- Laboratoire de Pharmacologie Médicale et Clinique de la Faculté de Médecine et du Centre Hospitalier, Universitaire de Toulouse, Toulouse, France.,INSERM UMR 1027, Faculté de Médecine, Université de Toulouse, Toulouse, France.,Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Pharmacopôle Midi-Pyrénées, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Muñoz LA, Reyes LE, Niño CG, Gomez WG, Diaz WR, Romero JC, Mendoza G, Arevalo JJ. Comparison of the pharmacodynamic profiles of three molecules of remifentanil in terms of hemodynamic response to laryngoscopy and tracheal intubation maneuvers. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2015.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Impact on resistance of the use of therapeutically equivalent generics: the case of ciprofloxacin. Antimicrob Agents Chemother 2014; 59:53-8. [PMID: 25313208 DOI: 10.1128/aac.03633-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Therapeutic nonequivalence of generic antibiotics may lead to treatment failure and enrichment of resistance. However, there has been no demonstration that an equivalent generic displays the same resistance selection profile as the innovator drug. We aimed to test this hypothesis with five generic versions of ciprofloxacin by assessing their pharmaceutical equivalence with microbiological assays and their efficacy against Pseudomonas aeruginosa PAO1 in the neutropenic murine thigh infection model. One equivalent generic was selected for analysis by high-pressure liquid chromatography-tandem mass spectrometry (LC-MS/MS), to confirm chemical identity, and resistance selection experiments in a hollow-fiber (HF) system simulating two clinical dosing regimens. Total and resistant populations were measured, and the MICs of the resistant cells with and without an efflux pump inhibitor were determined. LC-MS/MS found no differences between products, and the innovator and the generic selected resistance with the same magnitude and mechanism after 7 days of treatment in the HF system, supporting the fact that a generic with demonstrated equivalence in vivo is also equivalent regarding resistance selection.
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Gallelli L, Palleria C, De Vuono A, Mumoli L, Vasapollo P, Piro B, Russo E. Safety and efficacy of generic drugs with respect to brand formulation. J Pharmacol Pharmacother 2013; 4:S110-4. [PMID: 24347975 PMCID: PMC3853662 DOI: 10.4103/0976-500x.120972] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Generic drugs are equivalent to the brand formulation if they have the same active substance, the same pharmaceutical form and the same therapeutic indications and a similar bioequivalence respect to the reference medicinal product. The use of generic drugs is indicated from many countries in order to reduce medication price. However some points, such as bioequivalence and the role of excipients, may be clarified regarding the clinical efficacy and safety during the switch from brand to generic formulations. In conclusion, the use of generic drugs could be related with an increased days of disease (time to relapse) or might lead to a therapeutic failure; on the other hand, a higher drug concentration might expose patients to an increased risk of dose-dependent side-effects.
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Affiliation(s)
- Luca Gallelli
- Department of Health Science, Regional Center on drug information, Mater Domini University Hospital, Italy and Chair of Pharmacology, School of Medicine, University of Catanzaro, Italy
| | - Caterina Palleria
- Department of Health Science, Regional Center on drug information, Mater Domini University Hospital, Italy and Chair of Pharmacology, School of Medicine, University of Catanzaro, Italy
| | | | - Laura Mumoli
- Department of Health Science, Regional Center on drug information, Mater Domini University Hospital, Italy and Chair of Pharmacology, School of Medicine, University of Catanzaro, Italy
| | | | | | - Emilio Russo
- Department of Health Science, Regional Center on drug information, Mater Domini University Hospital, Italy and Chair of Pharmacology, School of Medicine, University of Catanzaro, Italy
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Even apparently insignificant chemical deviations among bioequivalent generic antibiotics can lead to therapeutic nonequivalence: the case of meropenem. Antimicrob Agents Chemother 2013; 58:1005-18. [PMID: 24277034 DOI: 10.1128/aac.00350-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Several studies with animal models have demonstrated that bioequivalence of generic products of antibiotics like vancomycin, as currently defined, do not guarantee therapeutic equivalence. However, the amounts and characteristics of impurities and degradation products in these formulations do not violate the requirements of the U.S. Pharmacopeia (USP). Here, we provide experimental data with three generic products of meropenem that help in understanding how these apparently insignificant chemical differences affect the in vivo efficacy. Meropenem generics were compared with the innovator in vitro by microbiological assay, susceptibility testing, and liquid chromatography/mass spectrometry (LC/MS) analysis and in vivo with the neutropenic guinea pig soleus infection model (Pseudomonas aeruginosa) and the neutropenic mouse thigh (P. aeruginosa), brain (P. aeruginosa), and lung (Klebisella pneumoniae) infection models, adding the dihydropeptidase I (DHP-I) inhibitor cilastatin in different proportions to the carbapenem. We found that the concentration and potency of the active pharmaceutical ingredient, in vitro susceptibility testing, and mouse pharmacokinetics were identical for all products; however, two generics differed significantly from the innovator in the guinea pig and mouse models, while the third generic was therapeutically equivalent under all conditions. Trisodium adducts in a bioequivalent generic made it more susceptible to DHP-I hydrolysis and less stable at room temperature, explaining its therapeutic nonequivalence. We conclude that the therapeutic nonequivalence of generic products of meropenem is due to greater susceptibility to DHP-I hydrolysis. These failing generics are compliant with USP requirements and would remain undetectable under current regulations.
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Tattevin P, Cremieux AC, Rabaud C, Gauzit R. Efficacy and Quality of Antibacterial Generic Products Approved for Human Use: A Systematic Review. Clin Infect Dis 2013; 58:458-69. [DOI: 10.1093/cid/cit769] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Comparison of six generic vancomycin products for treatment of methicillin-resistant Staphylococcus aureus experimental endocarditis in rabbits. Antimicrob Agents Chemother 2012; 57:1157-62. [PMID: 23254435 DOI: 10.1128/aac.01669-12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Concerns have recently emerged about the potency and the quality of generic vancomycin (VAN) products approved for use in humans, based on experiments in a neutropenic mouse thigh infection model. However, other animal models may be more appropriate to decipher the bactericidal activities of VAN generics in vivo and to predict their efficacy in humans. We aimed to compare the bactericidal activities of six generic VAN products currently used in France (Mylan and Sandoz), Spain (Hospira), Switzerland (Teva), and the United States (Akorn-Strides and American Pharmaceutical Products [APP]) in a rabbit model of aortic valve endocarditis induced by 8 × 10(7) CFU of methicillin-resistant Staphylococcus aureus (MRSA) strain COL (VAN MIC, 1.5 μg/ml). In vitro, there were no significant differences in the time-kill curve studies performed with the six generic VAN products. Ten rabbits in each group were treated with intravenous (i.v.) VAN, 60 mg/kg of body weight twice a day (b.i.d.) for 4 days. Mean peak serum VAN levels, measured 45 min after the last injection, ranged from 35.5 (APP) to 45.9 μg/ml (Teva). Mean trough serum VAN levels, measured 12 h after the last injection, ranged from 2.3 (Hospira) to 9.2 (APP) μg/ml. All generic VAN products were superior to controls (no treatment) in terms of residual organisms in vegetations (P < 0.02 for each comparison) and in the spleen (P < 0.005 for each comparison). Pairwise comparisons of generic VAN products found no significant differences. In conclusion, a stringent MRSA endocarditis model found no significant differences in the bactericidal activities of six generic VAN products currently used in Europe and America.
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