Generic Substitutions and Therapeutic Interchanges in Hospital Pharmacies: A Qualitative Study from Western Saudi Arabia

Facilitators and barriers to generic and biosimilar medications in the Middle East and North Africa: insights from physicians and pharmacists-a systematic review

BACKGROUND

The adoption of generic and biosimilar medications is crucial for improving healthcare accessibility and cost savings in the Middle East and North Africa (MENA) region. Understanding the factors that influence their acceptance is crucial for developing effective strategies for promoting their use.

PURPOSE

This systematic review aimed to examine the facilitators and barriers identified by healthcare professionals while prescribing and dispensing generic and biosimilar medications in the MENA region, focusing on their perceptions, knowledge, and attitudes.

METHODS

Following Cochrane guidelines and the "Guidance on the Conduct of Narrative Synthesis in Systematic Reviews," a comprehensive search of electronic databases and grey literature was conducted from 2012 to 2024. Studies assessing physicians' and pharmacists' perspectives on generics and biosimilars in the MENA region were included. Quality appraisal was performed using a standardized tool, the mixed methods appraisal tool (MMAT). The findings were synthesized using a descriptive analysis.

RESULTS

Of the 3570 screened citations, 39 met the inclusion criteria. Among them, 25 studies addressed facilitators and barriers to adopting generic medications, whereas 15 focused on biosimilars. Facilitators of generic medications included understanding the use of generics as cost-effective substitutes, supportive government policies, generic medication awareness, and pharmacists' empowerment to substitute medications. Barriers included knowledge gaps leading to distrust in efficacy and safety, the influence of pharmaceutical companies, cultural biases favoring brand name drugs, regulatory challenges, low consumer awareness, and concerns about pharmacists' profitability. Facilitators for biosimilars were mostly similar to generics, with an added emphasis on access benefit recognition when using biosimilars. Unique barriers included concerns about the lack of long-term safety data, hesitancy toward non-medical switching, and nocebo effect concerns. The quality assessment indicated that most studies were of moderate quality, with limitations such as sample size and representativeness, validity of the measurement tools, and potential biases of the researchers.

CONCLUSION

Significant knowledge gaps regarding regulatory approval, safety, and efficacy hinder the adoption of generic drugs and biosimilars in MENA. Targeted educational initiatives at the regulatory and payer levels are essential for bridging these gaps, enhancing awareness, and fostering acceptance. Implementing comprehensive educational programs for physicians and pharmacists is crucial to support the transition toward the greater use of generics and biosimilars.

A multi-site repeated prevalence study of medicine shortages in community pharmacies

Background

Medicine shortages are a global problem. Prior studies have focused on hospitals, and staff views, with less information on community practice. This study aimed to estimate the prevalence of medicine shortages in community pharmacies and potential impact on patients.

Method

Four community pharmacies (two urban, two rural) in Ireland recorded details of prescription request shortages per items dispensed. Data were gathered one study day per month from February to April 2023. A prevalence across sites was estimated and trends examined using a Poisson regression.

Results

There were 76 medicine requests defined as shortages out of 3734 prescription item requests, giving a mean shortage prevalence of 2% (95% CI 1.6-2.5%). There was a non-significant, 17%, increase in shortage rate across the study period (p = 0.256). Higher rates were observed in the two urban pharmacies. In total, 61/76 (80%) of shortages were associated with a delay in patient treatment.

Conclusion

Shortages are prevalent in community pharmacy and cause delays in patient treatment and increase in workload of pharmacy staff. Regulatory initiatives to address the issue at a manufacturer level have been proposed, although workforce planning, resourcing and professional role expansion are also required to protect pharmacy staff and patient outcomes.

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients-A Review PART II-Pharmacological Approach for Management of Elderly Patients with Peripheral Atherosclerotic Lesions outside Coronary Territory

BACKGROUND

Aging is a key risk factor for atherosclerosis progression that is associated with increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity, quality of life, and it is associated with reduced life expectancy. As most multicenter randomized trials exclude elderly and very elderly patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home, there is insufficient data on the management of older patients presenting with atherosclerotic lesions outside coronary territory. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment. In addition, due to a variety of severe comorbidities in the elderly, the average daily number of pills taken by octogenarians exceeds nine. Polypharmacy frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and non-adherence. Therefore, we have attempted to gather data on the medical treatment in patients with extra-cardiac atherosclerotic lesions indicating where there is some evidence of the management in elderly patients and where there are gaps in evidence-based medicine. Public PubMed databases were searched to review existing evidence on the effectiveness of lipid-lowering, antithrombotic, and new glucose-lowering medications in patients with extra-cardiac atherosclerotic occlusive disease.