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Zhou H, Wang Y, Chen J, He A, Jin J, Lu Q, Zhao Y, Li J, Hou M, Su L, Lai X, Wang W, Liu L, Ma Y, Gao D, Lai W, Zhou X, Jing H, Zhang J, Yang W, Ran X, Lin C, Hao J, Xiao T, Huang Z, Zhu Z, Wang Q, Fang B, Wang B, Song Y, Cai Z, Liu B, Zhu Y, Yang X, Kang X, Li J, Chen W. Efficacy and safety of generic pomalidomide plus low-dose dexamethasone in relapsed or refractory multiple myeloma: a multicenter, open-label, single-arm trial. Ann Hematol 2024; 103:855-868. [PMID: 38112795 PMCID: PMC10866745 DOI: 10.1007/s00277-023-05558-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
This multicenter, open-label, single-arm trial (ClinicalTrials.gov, NCT05236621) was conducted to confirm the efficacy and safety of generic pomalidomide plus dexamethasone in Chinese patients with relapsed or refractory multiple myeloma (RRMM). Total 79 eligible RRMM patients were planned to be included. Patients were treated with generic pomalidomide (4 mg daily on days 1-21, orally) and low-dose dexamethasone (40 mg/day on days 1, 8, 15, and 22, orally; 20 mg for patients aged > 75 years) in 28-day cycles until disease progression with a maximum treatment duration of 2 years. The primary endpoint is the overall response rate (ORR) assessed by the independent review committee per the 2016 International Myeloma Working Group guidelines. A total of 85 eligible patients were included in this study from 32 centers in China, with a median age of 62.0 (range, 39-76) years, a median prior line of therapy of 4 (range, 1-16), and 41.2% patients with high-risk cytogenetics. The ORR was 38.8% (95% confidence interval (CI), 28.44-50.01). The disease control rate was 67.1% (95% CI, 56.02-76.87), meanwhile, the median progression-free survival was 5.55 months (95% CI, 3.68-7.52). Among the treatment-related adverse events (TRAEs), infective pneumonia (17.6%) was the most frequent non-hematologic adverse event, while a decrease in neutrophil count (52.9%) was the most common grade ≥ 3 TRAE. The study results indicated that the generic pomalidomide demonstrated consistent efficacy and a safety profile similar to the branded pomalidomide when combined with low-dose dexamethasone in Chinese RRMM patients.Registration number ClinicalTrials.gov NCT05236621, retrospectively registered on February 11, 2022.
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Affiliation(s)
- Huixing Zhou
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, #8, the South Road of Workers Stadium of Chaoyang District, Beijing, 100020, China
| | - Yafei Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jiao Chen
- Department of Hematology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Aili He
- Department of Hematology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Quanyi Lu
- Department of Hematology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Ying Zhao
- Department of Hematology, The First People's Hospital of Foshan, Guangzhou, China
| | - Junjun Li
- Department of Hematology, The First Affiliated Hospital of University of South China, Hengyang, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
| | - Liping Su
- Department of Hematology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - Xun Lai
- Department of Hematology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming, China
| | - Wei Wang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lihong Liu
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanping Ma
- Department of Hematology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Da Gao
- Department of Hematology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wenhong Lai
- Department of Hematology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xin Zhou
- Department of Hematology, Wuxi People's Hospital, Wuxi, China
| | - Hongmei Jing
- Department of Hematology, Peking University Third Hospital, Beijing, China
| | - Jinqiao Zhang
- Department of Hematology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Yang
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuehong Ran
- Department of Hematology, Weifang People's Hospital, Weifang, China
| | - Congmeng Lin
- Department of Hematology, Zhangzhou Municicap Hospital of Fujian Province, Zhangzhou, China
| | - Jianping Hao
- Department of Hematology, The First Affiliated Hospital of Xinjiang Medical University, Urumchi, China
| | - Taiwu Xiao
- Department of Hematology, Liaocheng People's Hospital, Liaocheng, China
| | - Zhenqian Huang
- Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhigang Zhu
- Department of Geriatric Hematologic Oncology, Guangzhou First People's Hospital, Guangzhou, China
| | - Qing Wang
- Department of Hematopathology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Baijun Fang
- Department of Hematology, Henan Cancer Hospital, Affiliated Cancer Hospital of Zhenghzou University, Zhengzhou, China
| | - Binghua Wang
- Department of Hemolymph, Weihai Central Hospital, Weihai, China
| | - Yanping Song
- Department of Hematology, Xi'an Central Hospital, Xi'an, China
| | - Zhen Cai
- Bone Marrow Transplantation Center, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Bo Liu
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Yanan Zhu
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Xinai Yang
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Xiaoyan Kang
- Clinical Research Center, Qilu Pharmaceutical Co., Ltd., Jinan, China
| | - Juan Li
- Department of Hematology, First Affiliated Hospital of Sun Yat-Sen University, #58, The 2nd Zhongshan Road, Yuexiu District, Guangzhou, 510062, China.
| | - Wenming Chen
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, #8, the South Road of Workers Stadium of Chaoyang District, Beijing, 100020, China.
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Iliopoulos F, Tu D, Pence IJ, Li X, Ghosh P, Luke MC, Raney SG, Rantou E, Evans CL. Determining topical product bioequivalence with stimulated Raman scattering microscopy. J Control Release 2024; 367:864-876. [PMID: 38346503 DOI: 10.1016/j.jconrel.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
Generic drugs are essential for affordable medicine and improving accessibility to treatments. Bioequivalence (BE) is typically demonstrated by assessing a generic product's pharmacokinetics (PK) relative to a reference-listed drug (RLD). Accurately estimating cutaneous PK (cPK) at or near the site of action can be challenging for locally acting topical products. Certain cPK approaches are available for assessing local bioavailability (BA) in the skin. Stimulated Raman scattering (SRS) microscopy has unique capabilities enabling continuous, high spatial and temporal resolution and quantitative imaging of drugs within the skin. In this paper, we developed an approach based on SRS and a polymer-based standard reference for the evaluation of topical product BA and BE in human skin ex vivo. BE assessment of tazarotene-containing formulations was achieved using cPK parameters obtained within different skin microstructures. The establishment of BE between the RLD and an approved generic product was successfully demonstrated. Interestingly, within the constraints of the current study design the results suggest similar BA between the tested gel formulation and the reference cream formulation, despite the differences in the formulation/dosage form. Another formulation containing polyethylene glycol as the vehicle was demonstrated to be not bioequivalent to the RLD. Compared to using the SRS approach without a standard reference, the developed approach enabled more consistent and reproducible results, which is crucial in BE assessment. The abundant information from the developed approach can help to systematically identify key areas of study design that will enable a better comparison of topical products and support an assessment of BE.
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Affiliation(s)
- Fotis Iliopoulos
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown 02129, MA, USA
| | - Dandan Tu
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown 02129, MA, USA
| | - Isaac J Pence
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown 02129, MA, USA
| | - Xiaolei Li
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown 02129, MA, USA
| | - Priyanka Ghosh
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring 20993, MD, USA
| | - Markham C Luke
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring 20993, MD, USA
| | - Sam G Raney
- Office of Research and Standards, Office of Generic Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring 20993, MD, USA
| | - Elena Rantou
- Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring 20993, MD, USA
| | - Conor L Evans
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown 02129, MA, USA.
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Mangion K, Vella K, Gatt A, Vella AM, Borg M, Borg-Aquilina D, Douxfils J, Camilleri L, Riva N. A comparative in vitro study of the anticoagulant effect of branded versus generic rivaroxaban. Thromb Res 2024; 235:41-51. [PMID: 38295600 DOI: 10.1016/j.thromres.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 12/04/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Several generic formulations of rivaroxaban were recently marketed to be used interchangeably with their branded equivalent. However, there have been no previously published studies that directly compared the in vitro anticoagulant effect of branded vs. generic rivaroxaban. The aim of this in vitro study was to compare the effects of three raw rivaroxaban materials, obtained from the branded (Xarelto®) and two generic (Rivarolto® and Rivaroxaban Sandoz®) rivaroxaban formulations on an array of coagulation assays. METHODS A pool of normal plasma was spiked with several concentrations of the three rivaroxaban (range 50-750 ng/ml). The concentrations were assessed with a rivaroxaban calibrated anti-Xa assay and confirmed by ultra-high-performance liquid chromatography-mass spectrometry coupled with tandem mass spectrometry (UHPLC-MS/MS). The following assays were performed: Prothrombin time (PT), activated Partial Thromboplastin time (aPTT), Diluted Russell's Viper Venom Test (dRVVT), Thrombin time (TT), Clauss Fibrinogen, Factor VII, VIII and IX assays, and thromboelastography. RESULTS The results obtained by the three rivaroxaban at similar concentrations were comparable. Increasing concentrations of the three rivaroxaban showed a strong positive correlation with the PT, aPTT and dRVVT assays (r > 0.95, p < 0.01 for all), and a strong negative correlation with the Factors assays (r < -0.95, p < 0.01 for all). TT and Clauss Fibrinogen were not affected by rivaroxaban. No significant difference was identified in the mean assays' results obtained by the three rivaroxaban. CONCLUSION This study showed that the branded and generic rivaroxaban exert an identical in vitro anticoagulant effect across a wide range of concentrations.
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Affiliation(s)
- Karl Mangion
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - Kevin Vella
- Coagulation Laboratory, Department of Pathology, Mater Dei Hospital, Msida, Malta.
| | - Alex Gatt
- Coagulation Laboratory, Department of Pathology, Mater Dei Hospital, Msida, Malta; Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
| | - Amy Marie Vella
- Coagulation Laboratory, Department of Pathology, Mater Dei Hospital, Msida, Malta.
| | - Marica Borg
- Coagulation Laboratory, Department of Pathology, Mater Dei Hospital, Msida, Malta.
| | - Denise Borg-Aquilina
- National Blood Transfusion Service & Mater Dei Hospital Blood Bank, Msida, Malta.
| | - Jonathan Douxfils
- University of Namur, Faculty of Medicine, Department of Pharmacy, Namur Thrombosis and Hemostasis Center, Namur Research Institute for Life Sciences, Namur, Belgium; Qualiblood s.a., Qualiclinics, Namur, Belgium.
| | - Liberato Camilleri
- Department of Statistics & Operations Research, Faculty of Science, University of Malta, Msida, Malta.
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
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Bhartiya S, Ichhpujani P, Parmar UPS, Kapoor S, Kaundal S, Kumar S. Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals. J Curr Glaucoma Pract 2024; 18:16-22. [PMID: 38585162 PMCID: PMC10997958 DOI: 10.5005/jp-journals-10078-1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background Glaucoma is an optic neuropathy associated with characteristic structural damage to the optic nerve and associated visual dysfunction that may be caused by various pathological processes. A number of pharmacological agents are used to reduce the intraocular pressure (IOP), involving the usage of two or three medications concurrently. Literature is sparse regarding prescription patterns of antiglaucoma drugs, especially regarding variability in public sector vs private sector hospitals. Drug utilization studies can add insight for crafting rational, affordable, and ocular surface friendly prescriptions. Aim This study assessed the prescription pattern in glaucoma patients of a public sector, tertiary care hospital vs a private sector tertiary care hospital. Materials and methods In this retrospective study, pertinent data of diagnosed and labeled glaucoma patients were reviewed. Data collected included demographic details, type of glaucoma, number and nature of drugs prescribed, whether innovator or generic drugs were prescribed, if fixed-drug combinations (FDCs) and preservative-free formulations were prescribed. The prescription patterns between the two sectors were compared, as were the prescription patterns between primary open-angle glaucoma (POAG) and primary angle-closure disease (PACD). Results A total of 336 prescriptions were evaluated (216 from public sector, group I; 120 from private sector, group II). Travoprost 0.004% was the most prescribed antiglaucoma medication in both group I (30.09%) and group II (38.33%). Brimonidine and brinzolamide (14.17%) was the most prescribed combination in group II, while Brimonidine with Timolol (7.87%) in group I. In group I, Timolol and Travoprost were the most prescribed medications for both PACD and POAG. Conclusion This study showed that both public sector as well as private sector tertiary care centers prescribe antiglaucoma medications in tune with current principles of rational drug use. Preservative-free drugs were preferred in both the groups for better adherence. How to cite this article Bhartiya S, Ichhpujani P, Parmar UPS, et al.Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals. J Curr Glaucoma Pract 2024;18(1):16-22.
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Affiliation(s)
- Shibal Bhartiya
- Glaucoma Services, Department of Ophthalmology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
| | | | - Surbhi Kapoor
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
| | - Sonali Kaundal
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
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Dalsey T, Kim E, Chazin H, Ibrahim S. Global Postmarket Pharmacovigilance: A Generic Drug Perspective. Ther Innov Regul Sci 2023; 57:1180-1189. [PMID: 37563483 DOI: 10.1007/s43441-023-00558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
Despite the recognized need for generic drug pharmacovigilance harmonization efforts, only a few studies compared generic drug postmarket safety and surveillance methods adopted by regulatory agencies in different countries. The purpose of this research is to collect available information from a sample of international regulators with the overall goal of providing a general overview of each agency's decision-making processes for postmarket generic drug safety and surveillance. A structured four-part questionnaire of open-ended and multiple-choice questions along with a semi-structured interview were designed to elicit detailed information. Swissmedic, Medicines and Healthcare products Regulatory Agency (MHRA), Health Canada, and the U.S. Food and Drug Administration (FDA) provided information. Detailed information from participating regulatory agencies demonstrated some similarities and differences in their postmarket generic drug pharmacovigilance approaches. This study examines each agency's scientific perspective to address generic drug safety issues, as well as to identify common barriers within decision-making processes, such as legislative restrictions and limited resources. Most agencies do not have specific processes that are unique to generic drug products. This exploratory study, through documenting common and unique approaches intends to create a greater awareness and to promote cross-collaboration between global regulatory agencies.
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Affiliation(s)
- Taylor Dalsey
- U.S. Food and Drug Administration, Office of Generic Drugs, 10903 New Hampshire Avenue, Building 75, Room 3662, Silver Spring, MD, 20996, USA
| | - Edward Kim
- U.S. Food and Drug Administration, Office of Generic Drugs, 10903 New Hampshire Avenue, Building 75, Room 3662, Silver Spring, MD, 20996, USA
| | - Howard Chazin
- U.S. Food and Drug Administration, Office of Generic Drugs, 10903 New Hampshire Avenue, Building 75, Room 3662, Silver Spring, MD, 20996, USA.
| | - Sarah Ibrahim
- U.S. Food and Drug Administration, Office of Generic Drugs, 10903 New Hampshire Avenue, Building 75, Room 3662, Silver Spring, MD, 20996, USA
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Lechat P, Kir F, Marquet P, Woillard JB. Within-subject pharmacokinetic variability has a strong influence on individual exposure ratios in bioequivalence studies, hence on drug formulation interchangeability. Eur J Clin Pharmacol 2023; 79:1565-1578. [PMID: 37737912 DOI: 10.1007/s00228-023-03565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Bioequivalence between a reference and a generic drug is based on the hypothesis that a ± 20% change in blood exposure (or ± 10% for drugs with narrow therapeutic index, NTI) following the generic/reference switch will not have any therapeutic consequences. However, the individual exposure ratio between generic and reference can be higher than 1.20 (or 1.10). This study aims to analyse the different parameters influencing the individual exposure ratio, hence the conditions for reference/generic interchangeability. METHODS Bioequivalence studies with a double cross-over design for a virtual drug were simulated using 100 random sets of 12, 24, 48 or 100 pairs of areas under the curve (AUC), varying the generic/reference AUC geometric mean ratios between 0.80 and 1.25 and the within-subject exposure variance of the reference and the generic formulations. RESULTS The proportion of subjects with an exposure generic/reference ratio outside the ± 10% or ± 20% acceptance intervals increases when (1) the reference within-subject variance increases; (2) the ratio of the generic within-subject variance on the reference within-subject variance increases; and (3) the generic/reference mean AUC ratio diverges from 1.0. When only considering replicated administrations of the reference, the individual exposure ratio increases with the within-subject variance, yielding values outside the usually accepted individual exposure ratio range of 0.5 to 2 for drugs with narrow therapeutic index as soon as the within-subject variance standard deviation is ≥ 0.25 (equivalent to within-patient CV% > 25%). CONCLUSIONS Interchangeability between reference and generic formulations, especially for drugs with narrow therapeutic index can only be assumed if, the within-subject variance of generic is less or equal to the within-subject variance of reference or, if this is not the case, if the distribution of the generic/generic individual exposure ratios is included within the therapeutic margins of the reference drug.
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Affiliation(s)
- Philippe Lechat
- Paris-cité University, Paris, France.
- Pharmacology and Toxicology Department, Georges Pompidou European Hospital, Drug Evaluation unit, Agence Générale des équipements et des produits de santé (AGEPS), 7 rue du fer à moulin, 75005 Paris, Assistance Publique des Hôpitaux de Paris, France.
| | - Fatma Kir
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, 06100, Ankara, Turkey
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Lokman Hekim University, Ankara, Turkey
| | - Pierre Marquet
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
| | - Jean-Baptiste Woillard
- Inserm, Univ. Limoges, CHU Limoges, Pharmacology and Transplantation, U 1248, F-87000, Limoges, France
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Lim YC, Lee EK, Park MH. Factors influencing drug switching and changes in low-density lipoprotein-cholesterol levels with atorvastatin: a real-world observational study. Lipids Health Dis 2023; 22:151. [PMID: 37705044 PMCID: PMC10498597 DOI: 10.1186/s12944-023-01903-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Although generic drugs have been approved with the assurance of interchangeable applications with original drugs, some physicians, and patients still view their efficacy and interchangeability negatively. Using real-world data, we aimed to determine factors that impact switching between drugs that contain the same active ingredient, i.e., atorvastatin, and, in turn, whether this 'switch' could alter clinical outcomes. METHODS Using the National Health Insurance Service senior cohort, a retrospective cohort study was conducted to assess patients who had newly started atorvastatin 10 mg and had at least two records of national health examinations from 2010 to 2014. Drug switching, which was defined as a change in the atorvastatin product administered 90 days before the first and second examinations, was assessed. Greedy propensity score matching (1:2) was performed between switchers and non-switchers to control for potential confounders. Factors influencing switching were analyzed using multivariate logistic regression to estimate odds ratios and 95% confidence intervals (CIs). Changes in low-density lipoprotein-cholesterol (LDL-C) levels attributable to drug switching were evaluated using difference-in-differences regression. RESULTS A total of 1,588 patients were included, of whom 25.3% switched drugs (1,187 non-switchers and 401 switchers). Compared to patients taking generics before the first examination, those taking the original drugs had a lower odds ratio (0.31; 95% CI [0.21, 0.46]) for subsequent drug switching. A change in medical institution was associated with a significantly higher odds ratio (6.83; 95% CI [4.66, 10.02]). There were no significant differences in LDL-C alterations between switchers and non-switchers (0.42 mg/dL; 95% CI [-2.29, 3.13]). CONCLUSION The type of first-time drug administered and changes in medical institution can influence drug switching. No significant changes in LDL-C values were observed in the various switching scenarios between the original and generic drugs, suggesting their interchangeable application in real-world clinical practice.
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Affiliation(s)
- Yu-Cheol Lim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-Do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-Do, South Korea.
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-Do, South Korea.
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Suzuki T, Iwata M, Maezawa M, Inoue M, Satake R, Wakabayashi W, Oura K, Tanaka H, Hirofuji S, Miyasaka K, Goto F, Nakao S, Masuta M, Iguchi K, Nakamura M. Promoting generic drug usage in Japan: correlation between generic drug usage and monthly personal income. J Pharm Policy Pract 2023; 16:27. [PMID: 36814342 PMCID: PMC9948395 DOI: 10.1186/s40545-023-00532-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND To reduce pharmacy-related medical expenses, it is necessary to cut drug costs, potentially by increasing generic drug usage. This study analyzes the correlation between generic drug usage and monthly personal income by examining prescriptions for individual drugs. METHODS We conducted a cross-sectional study based on the data set from the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan and the Basic Survey on Wage Structure. We calculated the correlation coefficient between the usage rate of generic drugs in each prefecture of Japan and monthly personal incomes. We then analyzed the correlation coefficients based on the therapeutic categories of medicinal drugs; the contingency table was visualized as a mosaic plot. To compare the proportions between multiple categories, the chi-squared test was applied as a statistical significance test that was used in the analysis of n × m contingency tables. We worked with the null hypothesis that there were no differences between classes in the population. RESULTS Regarding the correlation coefficient between the usage rate of generic drugs and monthly personal incomes, the proportion of negative correlation coefficients for outpatient out-of-hospital and outpatient in-hospital prescriptions was over 70%, while that for inpatient prescriptions was 46.9%. The proportion of medicinal drugs exhibiting a negative correlation between the rates of generic drug usage and monthly personal incomes for outpatient out-of-hospital prescriptions and outpatient in-hospital prescriptions was higher than that of inpatient prescriptions. The proportion of statistically correlated medicinal drugs among inpatient prescriptions was lower than that among outpatient out-of-hospital and outpatient in-hospital prescriptions. The proportions of significant negative correlations for outpatient out-of-hospital, outpatient in-hospital, and inpatient prescriptions were 30.6%, 22.7%, and 3.5%, respectively. It was also observed that the rate of generic prescription usage for outpatient out-of-hospital and in-hospital prescriptions increased as monthly personal incomes decreased. In outpatients, the therapeutic categories with strong negative correlations were vasodilators and hyperlipidemia drugs. CONCLUSIONS Our results may help to increase the usage rate of generic drugs in different prefectures by providing useful information for promoting them throughout Japan.
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Affiliation(s)
- Takaaki Suzuki
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Mari Iwata
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,Yanaizu-Branch, Kifune Pharmacy, 2-23-2, Yanaizucho Hasuike, Gifu, 501-6103 Japan
| | - Mika Maezawa
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Misaki Inoue
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Riko Satake
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Wataru Wakabayashi
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Keita Oura
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Hideyuki Tanaka
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,Chubu Yakuhin Co. Ltd., 4-29 Takane-cho, Tajimishi, Gifu 507-0078 Japan
| | - Sakiko Hirofuji
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Koumi Miyasaka
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Fumiya Goto
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Satoshi Nakao
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,grid.411248.a0000 0004 0404 8415Division of Pharmacy, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Mayuko Masuta
- grid.411697.c0000 0000 9242 8418Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan ,grid.415597.b0000 0004 0377 2487Division of Pharmacy, Kyoto City Hospital, 1-2, Mibu Higashitakadacho, Nakagyo-ku, Kyoto, 604-8845 Japan
| | - Kazuhiro Iguchi
- grid.411697.c0000 0000 9242 8418Laboratory of Community Pharmacy, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196 Japan
| | - Mitsuhiro Nakamura
- Laboratory of Drug Informatics, Gifu Pharmaceutical University, 1-25-4, Daigaku Nishi, Gifu, 501-1196, Japan.
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Liu G, Xue J, Wang Y, Liu Z, Li X, Qu D, Su Z, Xu K, Qu X, Qu Z, Sun L, Cao M, Wang Y, Chen X, Yu J, Liu L, Deng Q, Zhao Y, Zhang L, Yang H. A randomized, open-label, two-cycle, two-crossover phase I clinical trial comparing the bioequivalence and safety of afatinib and Giotrif ® in healthy Chinese subjects. J Cancer Res Clin Oncol 2022; 149:2585-2593. [PMID: 35771264 DOI: 10.1007/s00432-022-04148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Afatinib is an oral, irreversible ErbB family blocker. It binds covalently to the kinase domains of epidermal growth factor (EGFR), HER2 and HER4, resulting in irreversible inhibition of tyrosine kinase autophosphorylation. Our trial compared the bioequivalence and safety between afatinib produced by Chia Tai Tianqing Pharmaceutical Group Co., Ltd. and Giotrif® produced by Boehringer Ingelheim. METHODS Healthy Chinese subjects (N = 36) were randomly divided into two groups at a ratio of 1:1. There was a single dose per period of afatinib and Giotrif®. The washout was set as 14 days. Plasma drug concentrations of afatinib and Giotrif® were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Statistical analysis of major pharmacokinetic (PK) parameters was conducted to assess drug bioequivalence. In addition, we evaluated the safety of the drugs throughout the trial. RESULTS The geometric mean ratios (GMRs) of Cmax, AUC0-t, and AUC0-∞ for afatinib and Giotrif® were 102.80%, 101.83%, and 101.58%, respectively. The 90% confidence intervals (CIs) were all within 80%-125%, meeting the bioequivalence standards. In addition, both drugs showed a good safety profile during the trial. CONCLUSION This study showed that afatinib was bioequivalent to Giotrif® in healthy Chinese subjects with well safety. CHINESE CLINICAL TRIAL REGISTRY This trial is registered at the Chinese Clinical Trial website ( http://www.chinadrugtrials.org.cn/index.html # CTR20171160).
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Affiliation(s)
- Guangwen Liu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Jinling Xue
- Department of Clinical Research Center, Chia Tai Tianqing Pharmaceutical Group Co., Ltd., Jiangsu, China
| | - Yanli Wang
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Zhengzhi Liu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Xue Li
- Department of Clinical Research Center, Chia Tai Tianqing Pharmaceutical Group Co., Ltd., Jiangsu, China
| | - Dongmei Qu
- Ansiterui Medical Technology Consulting Co., Ltd., Jilin, China
| | - Zhengjie Su
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Kaibo Xu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Xinyao Qu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Zhaojuan Qu
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Linlin Sun
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Mingming Cao
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Ying Wang
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Xuesong Chen
- Ansiterui Medical Technology Consulting Co., Ltd., Jilin, China
| | - Jing Yu
- Ansiterui Medical Technology Consulting Co., Ltd., Jilin, China
| | - Lang Liu
- Ansiterui Medical Technology Consulting Co., Ltd., Jilin, China
| | - Qiaohuan Deng
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China
| | - Yicheng Zhao
- Puheng Technology Co., Ltd. Shanghai, Shanghai, China
| | - Lixiu Zhang
- Lung Disease Center, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China.
| | - Haimiao Yang
- Phase I Clinical Trial Laboratory, Affiliated Hospital to Changchun University of Chinese Medicine, Jilin, China.
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10
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Wu D, Xie J, Dai H, Fang W. Consumption and cost trends of EGFR TKIs: influences of reimbursement and national price negotiation. BMC Health Serv Res 2022; 22:431. [PMID: 35365136 PMCID: PMC8973903 DOI: 10.1186/s12913-022-07868-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been widely used in the treatment of EGFR mutation non-small-cell lung cancer. The Chinese government has made great efforts to improve the availability and affordability of these drugs. The aim of this study was to investigate the trends in the consumption and cost of EGFR TKIs in Nanjing, a developed city in China, and evaluate the influence of health insurance coverage and national price negotiation on drug consumption. Methods Data about EGFR TKIs applications in 2010–2019 were extracted from Jiangsu Medicine Information Institute. Five types of EGFR TKIs were included. Consumption was expressed in defined daily doses (DDDs) and expenditure. The correlation between defined daily cost (DDC) and DDDs was analyzed by Pearson's correlation test. Results The DDC, number of DDDs and expenditure of EGFR TKIs changed little from 2010 to 2015. National price negotiation was initiated as a policy and low-price generic gefitinib came into the market in 2016. Three types of EGFR TKIs moved into the coverage of the national health insurance since 2017. Hence, the DDC decreased, and the number of DDDs increased significantly year by year since 2016. The first generation TKIs always made up of comprised the majority of the total consumption. The predominantly prescribed TKIs were gefitinib and icotinib. DDC was negatively correlated with the number of DDDs. The number of DDDs increased significantly after health insurance enrollment, price negotiation and generic drug replacement. Conclusion The consumption of EGFT TKIs has increased and the DDC of EGFR TKIs has decreased since 2016. These trends may be attributed to drug reimbursement, price negotiation and generic drug replacement. Further efforts are needed to translate the high consumption of EGFR TKIs into clinical benefits. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07868-9.
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Affiliation(s)
- Di Wu
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China
| | - Jianxiang Xie
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China
| | - Huizhen Dai
- Department of Pharmacy, Jiangsu Medicine Information Institute, Nanjing, 210029, China
| | - Wentong Fang
- Department of Pharmacy, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province, 210029, People's Republic of China.
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11
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梁 明, 邱 炜, 张 静, 黎 雪, 石 港, 翟 琼, 张 宇, 陈 志. Efficacy and safety of switching from brand-name to domestic generic levetiracetam in children with epilepsy. Zhongguo Dang Dai Er Ke Za Zhi 2022; 24:285-289. [PMID: 35351259 PMCID: PMC8974645 DOI: 10.7499/j.issn.1008-8830.2111033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To study the efficacy and safety of domestic generic levetiracetam in replacement of brand-name levetiracetam in the treatment of children with epilepsy. METHODS A retrospective analysis was performed on the medical data of 154 children with epilepsy who received domestic generic levetiracetam in the inpatient or outpatient service of Guangdong Provincial People's Hospital from May 2019 to December 2020. Domestic generic levetiracetam and brand-name levetiracetam were compared in terms of efficacy and safety. RESULTS For these 154 children, the epilepsy control rate was 77.3% (119/154) at baseline. At 6 months after switching to domestic generic levetiracetam, the epilepsy control rate reached 83.8% (129/154), which showed a significant increase (P<0.05). There was no significant change in the frequency of seizures from baseline to 6 months after switching (P>0.05). The incidence of refractory epilepsy in children with no response after switching treatment was significantly higher than that in children with response (P<0.05). Before switching, only 1 child (0.6%) experienced somnolence, while after switching, 3 children (1.9%) experienced mild adverse drug reactions, including dizziness, somnolence, irritability, and bad temper. CONCLUSIONS Switching from brand-name to generic levetiracetam is safe and effective and holds promise for clinical application, but more prospective randomized controlled trials are required in future.
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Affiliation(s)
- 明娟 梁
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
| | - 炜凤 邱
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
- 汕头大学医学院,广东汕头515041
| | - 静雯 张
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
| | - 雪萍 黎
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
- 汕头大学医学院,广东汕头515041
| | - 港安 石
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
| | - 琼香 翟
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
| | - 宇昕 张
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
| | - 志红 陈
- 广东省人民医院/广东省医学科学院儿科, 广东广州510080
- 汕头大学医学院,广东汕头515041
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Gahr M, Connemann BJ, Muche R, Zeiss R, Wolf A. Harmonization of summaries of product characteristics (SmPCs) of drugs with the same active ingredients: an evaluation of SmPCs of the most frequently prescribed active substances. Eur J Clin Pharmacol 2021; 78:419-434. [PMID: 34705065 PMCID: PMC8818637 DOI: 10.1007/s00228-021-03209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
Purpose In aut-idem or generic substitution, discrepancies between summaries of product characteristics (SmPCs) referring to the same active substance (AS) may cause difficulties regarding informed consent and medical liability. The qualitative and quantitative characteristics of such discrepancies are insufficiently studied, impeding harmonization of same-substance SmPCs and compromising safe drug treatment. Methods SmPCs of the one hundred most frequently prescribed ASs in Germany were analyzed for discrepancies in the presentation of indications (Inds) and contraindications (CInds). Inclusion and exclusion criteria of drugs/SmPCs were chosen according to the standards of the aut-idem substitution in Germany. Results According to the study protocol, we identified 1486 drugs, of which 1426 SmPCs could be obtained. 41% respectively 65% of the ASs had same-substance SmPCs that differed from the respective reference SmPC in the number of listed Inds respectively CInds. The number of listed Inds/CInds varied considerably between same-substance SmPCs with maximum ranges in Inds of 7 in amoxicillin, and in CInds of 11 in lisinopril. Many ASs had large proportions (> 50%) of associated same-substance SmPCs that differed from the respective reference SmPC. A considerable proportion of ASs had same-substance SmPCs with formal and content-related differences other than the discrepancy in the number of Inds/CInds. Conclusion This evaluation of same-substance SmPCs shows a clear lack of harmonization of same-substance SmPCs. Considering that generic substitution has become the rule and that physicians usually do not know which drug the patient receives in the pharmacy, these discrepancies raise several questions, that require a separate legal evaluation.
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Affiliation(s)
- Maximilian Gahr
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Leimgrubenweg 12-14, 89075, Ulm, Germany.
| | - Bernhard J Connemann
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Leimgrubenweg 12-14, 89075, Ulm, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstr. 13, 89075, Ulm, Germany
| | - René Zeiss
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Leimgrubenweg 12-14, 89075, Ulm, Germany
| | - Almuth Wolf
- Department of Psychiatry and Psychotherapy III, University Hospital of Ulm, Leimgrubenweg 12-14, 89075, Ulm, Germany
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Hsieh NH, Bois FY, Tsakalozou E, Ni Z, Yoon M, Sun W, Klein M, Reisfeld B, Chiu WA. A Bayesian population physiologically based pharmacokinetic absorption modeling approach to support generic drug development: application to bupropion hydrochloride oral dosage forms. J Pharmacokinet Pharmacodyn 2021; 48:893-908. [PMID: 34553275 DOI: 10.1007/s10928-021-09778-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/22/2021] [Indexed: 12/13/2022]
Abstract
We propose a Bayesian population modeling and virtual bioequivalence assessment approach to establishing dissolution specifications for oral dosage forms. A generalizable semi-physiologically based pharmacokinetic absorption model with six gut segments and liver, connected to a two-compartment model of systemic disposition for bupropion hydrochloride oral dosage forms was developed. Prior information on model parameters for gut physiology, bupropion physicochemical properties, and drug product properties were obtained from the literature. The release of bupropion hydrochloride from immediate-, sustained- and extended-release oral dosage forms was described by a Weibull function. In vitro dissolution data were used to assign priors to the in vivo release properties of the three bupropion formulations. We applied global sensitivity analysis to identify the influential parameters for plasma bupropion concentrations and calibrated them. To quantify inter- and intra-individual variability, plasma concentration profiles in healthy volunteers that received the three dosage forms, each at two doses, were used. The calibrated model was in good agreement with both in vitro dissolution and in vivo exposure data. Markov Chain Monte Carlo samples from the joint posterior parameter distribution were used to simulate virtual crossover clinical trials for each formulation with distinct drug dissolution profiles. For each trial, an allowable range of dissolution parameters ("safe space") in which bioequivalence can be anticipated was established. These findings can be used to assure consistent product performance throughout the drug product life-cycle and to support manufacturing changes. Our framework provides a comprehensive approach to support decision-making in drug product development.
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14
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Kajiwara E, Kamizato H, Shikano M. Dissolution Profiles of Generic Products in Dissolution Media Defined by Japanese Guidelines for Bioequivalence Studies. Ther Innov Regul Sci 2021; 55:1096-1100. [PMID: 34097289 DOI: 10.1007/s43441-021-00312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Abstract
The International Conference on Harmonisation (ICH) of Technical Requirements for Registration of Pharmaceuticals for Human Use M9 Guidelines for Biopharmaceutics Classification System Biowaivers reached harmonization in November 2019. However, guidelines for bioequivalence studies are not internationally harmonized, and water as a dissolution medium is only required in Japanese guidelines, regardless of drug solubility. This study investigated the dissolution profiles of generic products in Japan that differ from those of original drugs in dissolution media defined in guidelines. Dissolution profiles disclosed on websites of generic manufacturers were investigated for 262 active ingredients listed in the bluebook (4638 oral solid products listed in the National Health Insurance drug price list) issued by the Ministry of Health, Labour and Welfare. 5% of all generic products were different from the original products in dissolution media, of which 20% was observed in water only. Among the active pharmaceutical ingredients that showed different dissolution profiles only in water, the ratio of original products that showed slower dissolution profiles to the generics was 73%. The ratio of products showing different dissolution in water only was higher than in other media investigated in this study; however, these do not reflect disintegration and dissolution of drug products in the gastrointestinal tract, since bioequivalence has been confirmed in human studies and the generic products were approved by Japanese authorities. Therefore, a discussion about the required use of water as a dissolution medium in the Japanese guidelines is needed among industry, academia, and regulatory authorities.
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Affiliation(s)
- Eiji Kajiwara
- MSD K.K., KITANOMARU SQUARE, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667, Japan. .,Department of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan.
| | - Haruki Kamizato
- Department of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan
| | - Mayumi Shikano
- Department of Pharmaceutical Sciences, Tokyo University of Science, Tokyo, Japan
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15
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Vichare AS, Kamath SU, Leist M, Hayes AW, Mahadevan B. Application of the 3Rs principles in the development of pharmaceutical generics. Regul Toxicol Pharmacol 2021; 125:105016. [PMID: 34302895 DOI: 10.1016/j.yrtph.2021.105016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
Although the 3Rs are broadly applied in nonclinical testing, a better appreciation of the 3Rs is needed in the field of differentiated or value-added pharmaceutical generics because the minor changes in formulation, dosage form, indication, and application route often do not require additional safety testing. The US FDA and the EU EMA have comprehensive regulations for such drugs based on quality, therapeutic equivalence, and safety guidelines. However, no scientific publications on how the concept of replacement and reduction from 3Rs principles can be applied in the safety assessment of differentiated generics were found in the public domain. In this review, we discuss the application of 3Rs in nonclinical testing requirements for differentiated generics. Practical examples are provided in the form of case studies from regulated markets. We highlight the need for utilization of existing data to establish equivalence (differentiated generic vs innovator) in efficacy and safety. The case studies indicate that data requirements from animal experiments have been reduced to a large extent in some major markets without compromising quality and safety. In this context, we also highlight the problem that on a global scale, a true reduction of animal experiments will only be achieved when all countries adopt similar practices.
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Affiliation(s)
- Abhijit S Vichare
- Global Preclinical & Product Safety, Abbott Healthcare Pvt Ltd., Mumbai, India.
| | - Sushant U Kamath
- Global Preclinical & Product Safety, Abbott Healthcare Pvt Ltd., Mumbai, India
| | - Marcel Leist
- In vitro Toxicology and Biomedicine, University of Konstanz, Konstanz, Germany
| | - A Wallace Hayes
- The University of South Florida, College of Public Health, Tampa, FL, USA
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16
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Olsson P, Pearson K, Reimers A, Källén K. Widespread skeptic attitudes among people with epilepsy toward generic antiseizure drugs - A Swedish survey study. Epilepsy Behav 2021; 114:107554. [PMID: 33303376 DOI: 10.1016/j.yebeh.2020.107554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To explore associations between the characteristics of people with epilepsy (PWE) and their attitudes toward generic substitution of antiseizure drugs (ASDs) in epilepsy. METHODS This was a cross-sectional survey study directed at adults with epilepsy using selected brand drugs: Keppra®, Lamictal®, Lyrica® or Topimax®. Symptoms of anxiety and depression, sense of self-efficacy, and beliefs about medicines were assessed. Caregivers were asked to answer for persons with intellectual or communicative difficulties. RESULTS The total response rate was 41% (n = 178). Almost half (46%) of subjects stated that they would oppose generic substitution (Gen-NEG) if suggested by their neurologist, while 71% would worry about adverse effects and/or increased seizure frequency after a putative switch. Age ≥50 increased the odds of being Gen-NEG (adjusted OR: 2.20, 95% CI: 1.18-4.11). Negative associations with both Gen-NEG and worriers were found for education level of high-school diploma or above, employment/studies, and prior experience of generic ASD switch. The proportion of worriers was much higher among caregivers (21/22) compared to subjects with epilepsy (106/156). CONCLUSION High proportions of PWE express concerns regarding generic substitution of ASDs. The elderly and caregivers seem to express particular concerns. Identifying ways to diminish negative outcomes and worries in connection with a switch is an important future field of research in order to ensure high quality, cost-effective health care for the most vulnerable people in our societies.
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Affiliation(s)
- Patrik Olsson
- Dept. of Emergency Medicine, Helsingborg General Hospital, Helsingborg, Sweden; Dept. of Clinical Sciences Lund, Clinical Sciences Helsingborg, Lund University, Lund, Sweden.
| | - Kevin Pearson
- Dept. of Clinical Sciences Lund, Clinical Sciences Helsingborg, Lund University, Lund, Sweden.
| | - Arne Reimers
- Dept. of Clinical Chemistry and Pharmacology, Division of Laboratory Medicine, Lund, Sweden.
| | - Kristina Källén
- Dept. of Clinical Sciences Lund, Clinical Sciences Helsingborg, Lund University, Lund, Sweden; Dept. of Specialized Medicine, Helsingborg General Hospital, Helsingborg, Sweden; Dept. of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.
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17
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He L, Du X, Wang WH, Ma CS. [Comparison of compliance and cost effectiveness between brand-name statins and generic statins]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:1900-1904. [PMID: 33297658 DOI: 10.3760/cma.j.cn112338-20191114-00809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the differences of adherence, lipid reduction and cost-effectiveness between brand-name and generic statins. Methods: Statins prescription records of adult patients aged 18 years and above with the first prescription of statins between January 2015 to December 2017, were collected from community health information system of Chaoyang district of Beijing. Medication compliancy after first prescription was compared between group only taking brand-name statins (41 496 records) and group only taking generic statins (60 491 records). Lipid reduction and cost-effectiveness were also compared between two groups. Results: The medication compliancy of generic statins was worse than brand-name statins (28.2% vs. 36.2%, P<0.001). After excluding the influence of age, sex, history of hypertension and diabetes, and community correlation, generic atorvastatin (20 mg/day) showed better total cholesterol reduction effect [(0.86±0.07) mmol/L] and better low density lipid-cholesterol reduction effect [(0.67±0.07) mmol/L] one year later in 199 patients who consistently used it compared with brand-name atorvastatin at same dosage in 232 patients [(0.40±0.10) mmol/L and (0.42±0.08) mmol/L] (P<0.001, P=0.003). From the perspective of cost effectiveness, generic atorvastatin (20 mg/day) can reduce more than 50% of medical expenses at the same cholesterol reduction level. Conclusions: Generic statins might replace brand-name statins with similar treatment effect but lower medical expenses although its compliancy needs improvement. However, the data of adverse reactions of generic statins are lacking, it is necessary to carry out high-quality clinical research to improve and promote the development of generic statins.
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Affiliation(s)
- L He
- Department of Cardiology Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Beijing 100029, China
| | - X Du
- Department of Cardiology Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Beijing 100029, China
| | - W H Wang
- Department of Cardiology Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Beijing 100029, China
| | - C S Ma
- Department of Cardiology Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Office of Beijing Cardiovascular Diseases Prevention, Beijing 100029, China
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Mazer-Amirshahi M, Fox ER, Nelson LS, Smith SW, Stolbach AI. ACMT Position Statement on Prescription Drug Shortages. J Med Toxicol 2020; 16:349-351. [PMID: 32297150 PMCID: PMC7320088 DOI: 10.1007/s13181-020-00775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Erin R Fox
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | | | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, NY, USA
- Institute for Innovations in Medical Education, NYU Langone Health, New York, NY, USA
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Gonnelli S, Caffarelli C, Letizia Mauro G, Di Munno O, Malavolta N, Migliaccio S, Nuti R. Retrospective evaluation of persistence in osteoporosis therapy with oral bisphosphonates in Italy: the TOBI study. Aging Clin Exp Res 2019; 31:1541-7. [PMID: 31030419 DOI: 10.1007/s40520-019-01205-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
The patients' persistence with osteoporosis treatments is low. This retrospective, multicenter survey showed that almost 30% of osteoporotic patients discontinued the treatment within the first 6 months and that those taking drinkable bisphosphonates were less likely to interrupt the therapy; instead, the use of generic bisphosphonates was associated to a more precocious interruption. PURPOSE Low persistence with osteoporosis medications is associated with higher fracture risk. This study aimed to assess the persistence to treatment with oral bisphosphonates among Italian osteoporotic patients under treatment for at least 6 months and to evaluate whether the different oral formulations of bisphosphonates may influence the interruption of the therapy. METHODS 723 consecutive osteoporotic patients, aged 50 years or over, referred as outpatients for a follow-up visit after receiving a prescription of an oral bisphosphonate for the first time for at least 6 months were enrolled in this retrospective, multicenter survey carried out under conditions of usual clinical practice. All the patients enrolled were submitted to a standardized interview. RESULTS 191 patients turned out to have discontinued treatment (28.7%), the more common causes for interruption being the adverse events (43.9%), fear of adverse events (23.3%) and perceived absence of efficacy of the treatment (15.8%). The osteoporotic patients taking drinkable bisphosphonate or on treatment with aromatase inhibitors or under the age of 70 years were less likely to interrupt the treatment. However, these associations were no longer significant when the pharmaceutical formulation (generic vs branded) was included into the multivariate logistic regression model. CONCLUSION This study suggests that the new drinkable formulations of bisphosphonates could be an interesting option able to reduce upper GI adverse events, thus increasing persistence; whereas the generic formulations of bisphosphonates were associated to a premature discontinuation.
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Mishuk AU, Fasina I, Qian J. Impact of U.S. federal and state generic drug policies on drug use, spending, and patient outcomes: A systematic review. Res Social Adm Pharm 2020; 16:736-45. [PMID: 31445986 DOI: 10.1016/j.sapharm.2019.08.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prescription drugs contribute to increased healthcare expenditures in the United States (U.S.). Use of generic drugs has been recognized as an effective tool to control rising prescription drug costs. This study aimed to evaluate the impact of U.S. federal and state generic drug policies on drug use, spending, and patient outcomes. METHODS A systematic search was performed in June 2017, using PubMed, Web of Science, PsycINFO, and Business Source Premier. Search was limited to published articles in English language, including human subjects in the U.S., and with at least one outcome measure related to health service utilization, spending, or patient outcomes. RESULTS Thirty-four studies constituting seven key policy domains were included. Medicaid/Medicare Prior Authorization (PA) policies (n = 4) led to increased generic use, reduced patient and payer's spending on prescriptions without causing deterioration in patient's health-related quality of life. Medicare prescription plan's generic drug benefits (n = 4) had impact on increased generic use and generated savings, but the limited access to branded drugs may increase medication use gaps and risks of hospitalizations. State generic substitution laws (n = 3) caused increased generic use and cost savings for both consumers and states. Medicare/Medicaid coverage cap policies (n = 3) were associated with increased patient's out-of-pocket spending (OOP) and reduced prescription spending for payers. Policies lowering cost-sharing (n = 7) were associated with increased patient's medication use and adherence, but the impact varied by therapeutic classes. Existing evidence evaluating Medicare Part D (n = 12) suggested decreased prescription spending for beneficiaries and Medicare. Generic gap coverage reduced patient's OOP and Medicare spending. Finally, early evidence showed reduced consumers' OOP prescription spending after the ACA (n = 2). CONCLUSIONS Federal and state policies regarding generic drugs have resulted in reduced spending for consumers and payers. However, the overall impact on patient outcomes remains unclear.
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Long Z, Zhan Z, Guo Z, Li Y, Yao J, Ji F, Li C, Zheng X, Ren B, Huang T. A novel two-dimensional liquid chromatography - Mass spectrometry method for direct drug impurity identification from HPLC eluent containing ion-pairing reagent in mobile phases. Anal Chim Acta 2018; 1049:105-114. [PMID: 30612641 DOI: 10.1016/j.aca.2018.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/08/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
Abstract
In this study, a novel two dimensional liquid chromatography - mass spectrometry (2D-LC-MS) method with use of a weak anion exchange column between the 1st DLC RP column and the 2nd DLC RP column (RP1-WAX-RP2) was developed and applied to identify drug impurities from MS incompatible mobile phases containing sodium 1-octanesulfonate and non-volatile buffer. The 1st DLC conditions follow exactly the original standard HPLC method recorded in Chinese Pharmacopeia (ChP), European Pharmacopeia (EP) or US Pharmacopeia (USP). An impurity fraction was collected with a built-in sample loop (100 μL) and transferred to the WAX column where 1-octanesulfonate and phosphate were trapped and removed. While, the impurity and other cations were eluted to the 2nd D column (RP2) for separation and identification by connected IT-TOF MS. Methods were programmed and applied to identify impurities in two generic drugs, sulpiride (hydrophilic drug with logP 0.57) and dobutamine (hydrophobic drug with logP 3.6). The results indicate that the methods based on RP1-WAX-RP2 column configuration offer a feasible solution for direct impurity identification in generic drug product or API without needs of off-line desalting from the MS incompatible mobile phases containing ion-pairing reagent and non-volatile buffer.
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Affiliation(s)
- Zhen Long
- Shimadzu Scientific Instrument Company, Beijing, 100020, China
| | - Zhaoqi Zhan
- Shimadzu (Asia Pacific) Pte Ltd, 118264, Singapore
| | - Zhimou Guo
- Key Lab of Separation Science for Analytical Chemistry, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, 116023, China.
| | - Yueqi Li
- Shimadzu Scientific Instrument Company, Beijing, 100020, China.
| | - Jinting Yao
- Shimadzu Scientific Instrument Company, Beijing, 100020, China
| | - Feng Ji
- Shimadzu Scientific Instrument Company, Beijing, 100020, China
| | - Changkun Li
- Shimadzu Scientific Instrument Company, Beijing, 100020, China
| | - Xin Zheng
- Shimadzu Scientific Instrument Company, Beijing, 100020, China
| | - Biao Ren
- Shimadzu Scientific Instrument Company, Beijing, 100020, China
| | - Taohong Huang
- Shimadzu Scientific Instrument Company, Beijing, 100020, China
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Tachi T, Saito K, Esaki H, Sugita I, Yoshida A, Kanematsu Y, Noguchi Y, Umeda M, Yasuda M, Mizui T, Tsuchiya T, Goto C, Teramachi H. The adoption of generic drugs by a hospital: effects on drug dispensation among community pharmacies. J Pharm Health Care Sci 2018; 4:6. [PMID: 29564146 DOI: 10.1186/s40780-018-0102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background The objective of the current study is to elucidate the effect that the adoption of generic drugs by a large hospital has on the dispensation of generic drugs by community pharmacies. We evaluated the percentage of generic drugs dispensed by pharmacies and the cost of drugs dispensed before and after the adoption of generic drugs by a large hospital. Methods Participants comprised patients who were admitted to Gifu Municipal Hospital prior to its adoption of generic drugs (November 1, 2013 to November 14, 2013) and after its adoption (November 1, 2014 to November 14, 2014) and who utilized generic drugs dispensed by pharmacies. Results Results indicated that the pre-adoption dispensation rate of generic drugs by pharmacies was 48.3% (477/926 drugs), while the post-adoption rate was 57.7% (604/1046 drugs), indicating an increase of 9.4 points (P < 0.001). Furthermore, an investigation into the price paid for generic drugs as a percentage of the total price paid for all drugs indicated the following: the pre-adoption percentage was 23.5% (9756/41,461 yen), and the post-adoption percentage was 34.1% (19,221/56,438 yen), indicating an increase of 10.6 points (P < 0.001). Conclusions The results of this study revealed that the adoption of generic drugs by a hospital may promote the use of generic drugs by pharmacies and lead to reduced medical costs as well.
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Iskounen S, Simoneau G, Mouly S. [Prospective study of the factors associated with the acceptance of generics substitution by patients and their liberal doctors]. Rev Med Interne 2018; 39:849-854. [PMID: 29290412 DOI: 10.1016/j.revmed.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/25/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many prescribers and patients remain reluctant to substitution to generics. METHODS We conducted a prospective observational study, using semi-structured interviews adapted to identify factors independently associated with the acceptance of alternative to a generic drug by doctors and patients. RESULTS Between December 2014 and August 2015, 108 patients and 73 private doctors from Île-de-France and Nord-Pas-de-Calais were enrolled. Only 48 % of patients thought that the effectiveness and safety of generic were identical to the brand-name, 50 % had a favorable opinion and 36 % said they routinely accept substitution, especially when substitution was proposed by the general practitioner (68 % of patients). Age, gender, occupational status and the presence of a chronic condition were not associated to acceptance of substitution (P>0, 1), unlike the opinion (P<0.001), perception of efficacy (P<0.001) and side effects (P=0.0005). Two thirds of physicians substituted more than 50 % of their brand name prescription to generics. This low figure was due to patient request not to substitute (63.9 %). CONCLUSION The acceptance of substitution was independently associated to patient' opinion about generic drugs, further emphasizing the need for information campaigns dedicated to patients.
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Affiliation(s)
- S Iskounen
- Unité de recherches thérapeutiques, département de médecine interne, groupe hospitalier Lariboisière - Saint-Louis - Fernand-Widal, Assistance publique-hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - G Simoneau
- Unité de recherches thérapeutiques, département de médecine interne, groupe hospitalier Lariboisière - Saint-Louis - Fernand-Widal, Assistance publique-hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - S Mouly
- Unité de recherches thérapeutiques, département de médecine interne, groupe hospitalier Lariboisière - Saint-Louis - Fernand-Widal, Assistance publique-hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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Antoñanzas F, Juárez-Castelló CA, Rodríguez-Ibeas R. Endogenous versus exogenous generic reference pricing for pharmaceuticals. Int J Health Econ Manag 2017; 17:413-432. [PMID: 28508248 DOI: 10.1007/s10754-017-9216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/02/2017] [Indexed: 06/07/2023]
Abstract
In this paper we carry out a vertical differentiation duopoly model applied to pharmaceutical markets to analyze how endogenous and exogenous generic reference pricing influence competition between generic and branded drugs producers. Unlike the literature, we characterize for the exogenous case the equilibrium prices for all feasible relevant reference prices. Competition is enhanced after the introduction of a reference pricing system. We also compare both reference pricing systems on welfare grounds, assuming two different objective functions for health authorities: (i) standard social welfare and (ii) gross consumer surplus net of total pharmaceutical expenditures. We show that regardless of the objective function, health authorities will never choose endogenous reference pricing. When health authorities are paternalistic, the exogenous reference price that maximizes standard social welfare is such that the price of the generic drug is the reference price while the price of the branded drug is higher than the reference price. When health authorities are not paternalistic, the optimal exogenous reference price is such that the price of the branded drug is the reference price while the price of the generic drug is lower than the reference price.
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Affiliation(s)
- F Antoñanzas
- Department of Economics, University of La Rioja, 26004, Logroño, Spain
| | | | - R Rodríguez-Ibeas
- Department of Economics, University of La Rioja, 26004, Logroño, Spain.
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Freitas CG, Walsh M, Atallah ÁN. Design and rationale for the WARFA trial: a randomized controlled cross-over trial testing the therapeutic equivalence of branded and generic warfarin in atrial fibrillation patients in Brazil. BMC Cardiovasc Disord 2017; 17:148. [PMID: 28592234 PMCID: PMC5463418 DOI: 10.1186/s12872-017-0584-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/01/2017] [Indexed: 01/19/2023] Open
Abstract
Background Warfarin is a commonly used anticoagulant. Whether a given dose of the different formulations of Brazilian warfarin will result in the same effect on the international normalized ratio (INR) is uncertain. The aim of the WARFA trial is to determine whether the branded and two generic warfarins available in Brazil differ in their effect on the INR. Methods WARFA is a cross-over RCT comparing three warfarins. The formulations tested are the branded Marevan® (Uniao Quimica/Farmoquimica) and two generic warfarin (manufactured respectively by Uniao Quimica Farmaceutica Nacional and Laboratorio Teuto Brasileiro). All of them were manufactured in Brazil, are available in all settings of the Brazilian healthcare system and were purchased from retail drugstores. Eligible participants had atrial fibrillation or flutter, had been using warfarin for at least 2 months with a therapeutic range of 2.0–3.0 and had low variability in INR results during the 1st period of the trial. Our primary outcome, for which we have an equality hypothesis, is the difference between warfarins in the mean absolute difference between two INR results, obtained after three and 4 weeks with each drug. Our secondary outcomes, that will be tested for inequality (except for the mean INR, which will be tested for equality), include the difference in the warfarin dose, and time in therapeutic range. Clinical events and adherence were also recorded and will be reported. Discussion To our knowledge, WARFA will be the first comparison of the more readily applicable INR results between branded and generic warfarins in Brazil. WARFA is important because warfarins are commonly switched between in the course of a chronic treatment in Brazil. Final results of WARFA are expected in May 2017. Trial registration ClinicalTrials.gov NCT02017197 . Registered 11 December 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0584-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolina Gomes Freitas
- Department of Medicine, Universidade Federal de São Paulo (UNIFESP), CEPATIS, Rua Botucatu, 740 - 3o andar, São Paulo/SP, CEP 04023-900, Brazil. .,Cochrane Brazil, Rua Borges Lagoa, 564 - cj 63, São Paulo/SP, CEP 04038-000, Brazil.
| | - Michael Walsh
- Department of Medicine (Nephrology) and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.,Population Health Research Institute, McMaster University/Hamilton Health Sciences, Hamilton, Canada
| | - Álvaro Nagib Atallah
- Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de Sao Paulo (UNIFESP), CEPATIS, Rua Botucatu, 740 - 3o andar, São Paulo/SP, CEP 04023-900, Brazil.,Cochrane Brazil, Rua Borges Lagoa, 564 - cj 63, São Paulo/SP, CEP 04038-000, Brazil
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Antoñanzas F, Juárez-Castelló CA, Rodríguez-Ibeas R. Implementing personalized medicine with asymmetric information on prevalence rates. Health Econ Rev 2016; 6:35. [PMID: 27539222 PMCID: PMC4990530 DOI: 10.1186/s13561-016-0113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/22/2016] [Indexed: 06/06/2023]
Abstract
Although personalized medicine is becoming the new paradigm to manage some diseases, the economics of personalized medicine have only focused on assessing the efficiency of specific treatments, lacking a theoretical framework analyzing the interactions between pharmaceutical firms and healthcare systems leading to the implementation of personalized treatments. We model the interaction between the hospitals and the manufacturer of a new treatment as an adverse selection problem where the firm does not have perfect information on the prevalence across hospitals of the genetic characteristics of the patients making them eligible to receive a new treatment. As a result of the model, hospitals with high prevalence rates benefit from the information asymmetry only when the standard treatment is inefficient when applied to the patients eligible to receive the new treatment. Otherwise, information asymmetry has no value. Personalized medicine may be fully or partially implemented depending on the proportion of high prevalence hospitals.
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Affiliation(s)
- Fernando Antoñanzas
- Department of Economics, University of La Rioja, Cigüeña 60, 26006, Logrono, Spain.
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Lee CY, Chen X, Romanelli RJ, Segal JB. Forces influencing generic drug development in the United States: a narrative review. J Pharm Policy Pract 2016; 9:26. [PMID: 27688886 PMCID: PMC5034442 DOI: 10.1186/s40545-016-0079-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background The United States (U.S.) Food and Drug Administration, as protectors of public health, encourages generic drug development and use so that patients can access affordable medications. The FDA, however, has limited mechanisms to encourage generic drug manufacturing. Main results Generic drug manufacturers make decisions regarding development of products based on expected profitability, influenced by market forces, features of the reference listed drug, and manufacturing capabilities, as well as regulatory restrictions. Barriers to the development of generic drugs include the challenge of demonstrating bioequivalence of some products, particularly those that are considered to be complex generics. Conclusions We present here a focused review describing the influences on generic manufacturers who are prioritizing drugs for generic development. We also review proposed strategies that regulators may use to incentivize generic drug development.
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Affiliation(s)
- Chia-Ying Lee
- Johns Hopkins University Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA
| | - Xiaohan Chen
- Johns Hopkins University Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA
| | | | - Jodi B Segal
- Johns Hopkins University Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA ; Division of General Internal Medicine, Johns Hopkins University School of Medicine, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA
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Manzoli L, Flacco ME, Boccia S, D'Andrea E, Panic N, Marzuillo C, Siliquini R, Ricciardi W, Villari P, Ioannidis JPA. Generic versus brand-name drugs used in cardiovascular diseases. Eur J Epidemiol 2016; 31:351-68. [PMID: 26620809 PMCID: PMC4877434 DOI: 10.1007/s10654-015-0104-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/25/2015] [Indexed: 12/21/2022]
Abstract
This meta-analysis aimed to compare the efficacy and adverse events, either serious or mild/moderate, of all generic versus brand-name cardiovascular medicines. We searched randomized trials in MEDLINE, Scopus, EMBASE, Cochrane Controlled Clinical Trial Register, and ClinicalTrials.gov (last update December 1, 2014). Attempts were made to contact the investigators of all potentially eligible trials. Two investigators independently extracted and analyzed soft (including systolic blood pressure, LDL cholesterol, and others) and hard efficacy outcomes (including major cardiovascular adverse events and death), minor/moderate and serious adverse events. We included 74 randomized trials; 53 reported ≥1 efficacy outcome (overall sample 3051), 32 measured mild/moderate adverse events (n = 2407), and 51 evaluated serious adverse events (n = 2892). We included trials assessing ACE inhibitors (n = 12), anticoagulants (n = 5), antiplatelet agents (n = 17), beta-blockers (n = 11), calcium channel blockers (n = 7); diuretics (n = 13); statins (n = 6); and others (n = 3). For both soft and hard efficacy outcomes, 100 % of the trials showed non-significant differences between generic and brand-name drugs. The aggregate effect size was 0.01 (95 % CI -0.05; 0.08) for soft outcomes; -0.06 (-0.71; 0.59) for hard outcomes. All but two trials showed non-significant differences in mild/moderate adverse events, and aggregate effect size was 0.07 (-0.06; 0.20). Comparable results were observed for each drug class and in each stratified meta-analysis. Overall, 8 serious possibly drug-related adverse events were reported: 5/2074 subjects on generics; 3/2076 subjects on brand-name drugs (OR 1.69; 95 % CI 0.40-7.20). This meta-analysis strengthens the evidence for clinical equivalence between brand-name and generic cardiovascular drugs. Physicians could be reassured about prescribing generic cardiovascular drugs, and health care organization about endorsing their wider use.
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Affiliation(s)
- Lamberto Manzoli
- Department of Medicine and Aging Sciences, University of Chieti, Via dei Vestini 5, 66013, Chieti, Italy.
- Regional Health Care Agency of Abruzzo, Via Attilio Monti 9, Pescara, Italy.
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences, University of Chieti, Via dei Vestini 5, 66013, Chieti, Italy
- Regional Health Care Agency of Abruzzo, Via Attilio Monti 9, Pescara, Italy
| | - Stefania Boccia
- Institute of Public Health, Catholic University of Rome, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Elvira D'Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Nikola Panic
- Institute of Public Health, Catholic University of Rome, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5bis, 10126, Turin, Italy
| | - Walter Ricciardi
- Institute of Public Health, Catholic University of Rome, Largo Francesco Vito, 1, 00168, Rome, Italy
- Italian National Institute of Health, Via Regina Elena 299, 00161, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Viale Regina Elena 324, 00161, 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, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford, CA, USA
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Tang F, Zhou R, Cheng Z, Yang G, Chen A, Liu Z, Tan H, Yang S, Li S, Mu L, Yu P. Implementation of a reference-scaled average bioequivalence approach for highly variable generic drug products of agomelatine in Chinese subjects. Acta Pharm Sin B 2016; 6:71-8. [PMID: 26904401 PMCID: PMC4724689 DOI: 10.1016/j.apsb.2015.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/20/2015] [Accepted: 10/12/2015] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to apply the reference-scaled average bioequivalence (RSABE) approach to evaluate the bioequivalence of 2 formulations of agomelatine, and to investigate the pharmacokinetic properties of agomelatine in Chinese healthy male subjects. This was performed in a single-dose, randomized-sequence, open-label, four-way crossover study with a one-day washout period between doses. Healthy Chinese males were randomly assigned to receive 25 mg of either the test or reference formulation. The formulations were considered bioequivalent if 90% confidence intervals (CIs) for the log-transformed ratios and ratio of geometric means (GMR) of AUC and Cmax of agomelatine were within the predetermined bioequivalence range based on RSABE method. Results showed that both of the 90% CIs for the log-transformed ratios of AUC and Cmax of 7-desmethyl-agomelatine and 3-hydroxy-agomelatine were within the predetermined bioequivalence range. The 90% CIs for natural log-transformed ratios of Cmax, AUC0–t and AUC0–∞ of agomelatine (104.42–139.86, 101.33–123.83 and 97.90–117.94) were within the RSABE acceptance limits, and 3-hydroxy-agomelatine (105.55–123.03, 101.95–109.10 and 101.72–108.70) and 7-desmethyl-agomelatine (104.50–125.23, 102.36–111.50 and 101.62–110.64) were within the FDA bioequivalence definition intervals (0.80–1.25 for AUC and 0.75–1.33 for Cmax). The RSABE approach was successful in evaluating the bioequivalence of these two formulations.
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Koga K, Kikuchi H. Comparative study for pharmaceutical quality among bland-name drug and generic drugs of compound glycyrrhizin injections in China. J Basic Clin Pharm 2014; 3:346-51. [PMID: 24826049 PMCID: PMC3979248 DOI: 10.4103/0976-0105.105338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The physicochemical properties (pH and osmolarity), ingredients, and impurities containing in compound glycyrrhizin injections (eight items) marketed in China were compared with those in bland-name drug (Stronger Neo-Minophagen C injection). Glycyrrhizin (GZ), glycine (Gly), and l-cysteine (CysH) as the ingredients, moreover, glycyrrhetinic acid (GA), 3-monoglucuronyl-glycyrrhetinic acid (MGGA), and l-cystine (CysS) as the impurity were determined by HPLC. The pH and osmolarity were different every each pharmaceutical product, but the variation between batch was very small. On the other hand, although the contents of GZ, Gly, and CysH in bland-name drug were approximately 100% of the label claim, the contents of GZ in generic drugs were the range of 91.8-100.9%, indicating the GZ contents in four products were clearly less than value indicated in label (<97%). The remarkable difference was not accepted by impurities content such as GA and MGGA. The contents of CysH in generic drugs were the range of 79.9-100.4%, and CysS was determined in all generic drugs, suggesting that CysH may decompose to be CysS depending on the pH of injections in generic drug only. Because the variation of the ingredient content was big and products with a little quantity for the ingredients were recognized, establishment of the preparation that can maintain the prescribed ingredient content and the severity of the assay will be required.
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Affiliation(s)
- Kenjiro Koga
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3, Kanagawa-machi, Kanazawa, Japan
| | - Hironori Kikuchi
- Department of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3, Kanagawa-machi, Kanazawa, Japan
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Park YM, Ahn T, Lee K, Shin KC, Jung ES, Shin DS, Kim MG, Kang WC, Han SH, Choi IS, Shin EK. A comparison of two brands of clopidogrel in patients with drug-eluting stent implantation. Korean Circ J 2012; 42:458-63. [PMID: 22870079 PMCID: PMC3409394 DOI: 10.4070/kcj.2012.42.7.458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/15/2011] [Accepted: 01/08/2012] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Although generic clopidogrel is widely used, clinical efficacy and safety between generic and original clopidogrel had not been well evaluated. The aim of this study was to evaluate the clinical outcomes of 2 oral formulations of clopidogrel 75 mg tablets in patients with coronary artery disease (CAD) undergoing drug-eluting stent (DES) implantation. Subjects and Methods Between July 2006 and February 2009, 428 patients that underwent implantation with DES for CAD and completed >1 year of clinical follow-up were enrolled in this study. Patients were divided into the following 2 groups based on treatment formulation, Platless® (test formulation, n=211) or Plavix® (reference formulation, n=217). The incidence of 1-year major adverse cardiovascular and cerebrovascular event (MACCE) and stent thrombosis (ST) were retrospectively reviewed. Results The baseline demographic and procedural characteristics were not significantly different between two treatment groups. The incidence of 1-year MACCEs was 8.5% {19/211, 2 deaths, 4 myocardial infarctions (MIs), 2 strokes, and 11 target vessel revascularizations (TVRs)} in Platless® group vs. 7.4% (16/217, 4 deaths, 1 MI, 2 strokes, and 9 TVRs) in Plavix® group (p=0.66). The incidence of 1-year ST was 0.5% (1 definite and subacute ST) in Platless® group vs. 0% in Plavix® group (p=0.49). Conclusion In this study, the 2 tablet preparations of clopidogrel showed similar rates of MACCEs, but additional prospective randomized studies with pharmacodynamics and platelet reactivity are needed to conclude whether generic clopidgrel may replace original clopidogrel.
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Affiliation(s)
- Yae Min Park
- Cardiology Division, Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
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