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Rwagitinywa J, Lapeyre-Mestre M, Bourrel R, Montastruc JL, Sommet A. Comparison of adherence to generic multi-tablet regimens vs. brand multi-tablet and brand single-tablet regimens likely to incorporate generic antiretroviral drugs by breaking or not fixed-dose combinations in HIV-infected patients. Fundam Clin Pharmacol 2018; 32:450-458. [PMID: 29505661 DOI: 10.1111/fcp.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/27/2018] [Accepted: 02/27/2018] [Indexed: 12/01/2022]
Abstract
Adherence to antiretroviral (ARV) is crucial to achieve viral load suppression in HIV-infected patients. This study aimed to compare adherence to generic multi-tablet regimens (MTR) vs. brand MTR likely to incorporate ARV drugs without breaking fixed-dose combinations (FDC) and brand single-tablet regimens (STR) likely to incorporate generics by breaking the FDC. Patients aged of 18 years or over exposed to one of the generic or the brand of lamivudine (3TC), zidovudine/lamivudine (AZT/TC), nevirapine (NVP), or efavirenz (EFV), or the brand STR of efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF). Adherence was measured by medication possession ratio (MPR) using both defined daily dose (DDD) and daily number of tablet recommended for adults (DNT). Adherence to generic MTR vs. brand MTR and brand STR was compared using Kruskal-Wallis. The overall median adherence was 0.97 (IQR 0.13) by DNT method and 0.97 (0.14) by DDD method. Adherence in patients exposed to generic MTR (n = 165) vs. brand MTR (n = 481) and brand STR (n = 470) was comparable by DNT and DDD methods. In conclusion, adherence to generic MTR was high and comparable with adherence to brand MTR and to STR. Utilization of DDD instead DNT to measure the MPR led to small but nonsignificant difference that has no clinical impact.
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Affiliation(s)
- Joseph Rwagitinywa
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059, Toulouse Cedex 9, France
| | - Robert Bourrel
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés (CNAMTS), Direction de l'échelon médical, 3 Boulevard Léopold Escande, 31000, Toulouse, France
| | - Jean-Louis Montastruc
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059, Toulouse Cedex 9, France
| | - Agnès Sommet
- Medical and Clinical Pharmacology Unit, Toulouse University Hospital, 37 Allées Jules Guesde, 31000, Toulouse, France.,UMR NSERM 1027, University Toulouse III, 37 Allées Jules Guesde, 31000, Toulouse, France.,CIC 1436, Toulouse University Hospital, Place du Docteur Baylac - TSA 40031, 31059, Toulouse Cedex 9, France
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Rwagitinywa J, Lapeyre-Mestre M, Bourrel R, Sommet A. Generic antiretroviral drug use in HIV-infected patients: A cohort study from the French health insurance database. Therapie 2017; 73:257-266. [PMID: 29195713 DOI: 10.1016/j.therap.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/26/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to estimate the rate of generic users among HIV-infected patients treated by antiretroviral (ARV) drugs potentially substitutable and to determine factors associated with switch from brand to generic ARV in real-life settings in a French region. METHODS Cohort of HIV-infected patients aged of ≥18 years, exposed to at least one of the generic of lamivudine (3TC-150mg/300mg), zidovudine/lamivudine (AZT-200mg/3TC-150mg), nevirapine (NVP-200mg), efavirenz (EFV-600mg) and those exposed to brand 3TC, AZT/3TC, NVP, EFV, the fixed-dose combination abacavir/lamivudine (ABC/3TC) or the single-tablet regimen efavirenz/emtricitabine/tenofovir (EFV/FTC/TDF) as recorded in the French health insurance database between January 2012 and May 2015 were included. Factors associated with switch (for each generic versus its brand drug; and for situation requiring breaking the combination) were investigated through a logistic regression. RESULTS Among the 1539 patients likely to switch from brand ARV drugs, only 165 (11%) were exposed to generics. For EFV users, switch from brand to generic was associated with age (aOR=1.04 [CI: 1.00-1.08]). For ABC/3TC users, switch was significantly more frequent in patients receiving a monthly average of more than two non-ARV drugs (3.08 [1.42-6.68]) and whose regimen contained a non-nucleoside reverse transcriptase inhibitor (NNRTI) as index medication (3rd agent) (5.68 [2.68-11.39]). By contrast, switch was less frequent in AZT/3TC users exposed to drugs used in digestive disorders (0.39 [0.18-0.88]) or analgesics (0.42 [0.20-0.90]). CONCLUSION Treatment-experienced HIV patients whose disease has been stabilized (less comorbidities) are more likely to switch to generic antiretroviral drugs.
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Affiliation(s)
- Joseph Rwagitinywa
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France.
| | - Maryse Lapeyre-Mestre
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France; CIC 1436, Toulouse university hospital, 31000 Toulouse, France
| | - Robert Bourrel
- Direction de l'échelon médical, Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 31000 Toulouse, France
| | - Agnès Sommet
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, 31000 Toulouse, France; UMR Inserm 1027, faculté de médecine, university Toulouse III, 31000 Toulouse, France; CIC 1436, Toulouse university hospital, 31000 Toulouse, France
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