Клиническая эквивалентность генериков и оригинальных препаратов, применяемых в кардиологии: что нам известно?
Клиническая эквивалентность генериков и оригинальных препаратов, применяемых в кардиологии: что нам известно?
Леонова М.В. Клиническая эквивалентность генериков и оригинальных препаратов, применяемых в кардиологии: что нам известно? Consilium Medicum. 2021;23(12):920–927.
DOI: 10.26442/20751753.2021.12.201290
________________________________________________
Leonova MV. Clinical equivalence of generic and brand-name drugs used in cardiology: what do we know? Consilium Medicum. 2021;23(12):920–927. DOI: 10.26442/20751753.2021.12.201290
Клиническая эквивалентность генериков и оригинальных препаратов, применяемых в кардиологии: что нам известно?
Леонова М.В. Клиническая эквивалентность генериков и оригинальных препаратов, применяемых в кардиологии: что нам известно? Consilium Medicum. 2021;23(12):920–927.
DOI: 10.26442/20751753.2021.12.201290
________________________________________________
Leonova MV. Clinical equivalence of generic and brand-name drugs used in cardiology: what do we know? Consilium Medicum. 2021;23(12):920–927. DOI: 10.26442/20751753.2021.12.201290
Проблема использования генериков в лечении пациентов с сердечно-сосудистыми заболеваниями актуальна не одно десятилетие. Обеспокоенность врачей, фармацевтов и пациентов не уменьшается в связи с постоянным ростом сердечно-сосудистой заболеваемости и смертности в мире. По данным систематического обзора 186 публикаций, врачи выявили озабоченность по поводу качества, надежности и возможности замены оригинальных лекарственных средств; фармацевты показали наивысшую степень одобрения генериков. Было выявлено недоверие пациентов к генерикам, вызванное недостатком информации, опасениями относительно упаковки, наличием негативного опыта замены оригинального препарата. В трех метаанализах проведено сравнение генерических и оригинальных препаратов кардиоваскулярных групп по эффективности и безопасности. В метаанализе 2008 г. (47 исследований, 9 классов кардиоваскулярных препаратов) оценено влияние на мягкие исходы, в метаанализе 2016 г. (74 исследования, 7 классов препаратов) оценены еще и побочные эффекты. Совокупный эффект выявил небольшую и недостоверную разницу, что указывало на отсутствие превосходства оригинальных препаратов над генериками; не было выявлено различий по частоте и выраженности побочных эффектов между генериками и оригинальными препаратами. В метаанализе 2020 г. (72 исследования, 9 классов препаратов) проведена оценка частоты обращения в стационары (включая консультации в отделении неотложной помощи, госпитализацию) и выявлено достоверное увеличение риска для генериков по любой причине (на 14%), но не по сердечно-сосудистым заболеваниям. Обзор 8 когортных исследований по оценке антигипертензивных препаратов по отдаленным сердечно-сосудистым исходам, длительности удержания на терапии и эффекту замены не выявил существенных различий между генериками и брендами. В систематическом обзоре исследований по сравнению варфарина и генериков не выявлено достоверных различий по показателю международного нормализованного отношения и частоте тромбоэмболических и геморрагических осложнений; однако в одном исследовании частота посещений больниц была на 10% выше для генериков. В систематическом обзоре исследований по сравнению клопидогрела и генериков показана сопоставимость препаратов для основных сердечно-сосудистых событий и смертности. Обзор 5 когортных исследований по оценке оригинальных статинов и генериков показал сопоставимость по частоте общей смертности и главных сердечно-сосудистых событий, кроме одного исследования с противоположными результатами. Метаанализы и крупные наблюдательные исследования свидетельствуют, что генерики имеют не худшую эффективность, иногда даже превосходят таковую оригинальных препаратов и могут оправданно применяться в клинической практике.
The problem of using generics in the treatment of patients with cardiovascular diseases remains relevant for more than a decade. The concern of doctors, pharmacists and patients is not diminishing with the constant rise in cardiovascular morbidity and mortality worldwide. Based on a systematic review of 186 publications, physicians identified concerns about the quality, reliability and replaceability of original drugs; pharmacists have shown the highest level of generic approval. Patients’ distrust of generics was revealed, caused by a lack of information, concerns about packaging, and negative experience of replacing the original drug. Three meta-analyzes compared generic and original drugs of cardiovascular groups in terms of efficacy and safety.
A 2008 meta-analysis (47 studies, 9 classes of cardiovascular drugs) assessed the effect on mild outcomes, a 2016 meta-analysis (74 studies, 7 classes of drugs) also assessed side effects. The cumulative effect revealed a small and nonsignificant difference, which indicated that there was no superiority of original drugs over generics; there were no differences in the frequency and severity of side effects between generics and original drugs. A 2020 meta-analysis (72 studies, 9 drug classes) assessed the frequency of hospital admissions (including emergency department consultations, hospitalizations) and found a significant increase in the risk for generics for any reason (14%), but not for cardiac vascular diseases. A review of 8 cohort studies evaluating antihypertensive drugs for long-term cardiovascular outcomes, duration of retention, and substitution effect did not find significant differences between generics and brands. In a systematic review of studies comparing warfarin and generics, there were no significant differences in international normalized ratio and the incidence of thromboembolic and hemorrhagic complications; however, in one study, the frequency of hospital visits was 10% higher for generics. A systematic review of studies comparing clopidogrel versus generics shows drug comparability for major cardiovascular events and mortality. A review of 5 cohort studies evaluating originator statins and generics showed comparable rates of all-cause mortality and major cardiovascular events, except for one study with conflicting results. Meta-analyzes and large observational studies indicate that generics are not the worst efficacy, sometimes even surpass that of original drugs and can be justifiably used in clinical practice.
1. World Health Organization (WHO). Generic drugs. Geneva: WHO, 2015.
2. US Food and Drug Administration (FDA). Generic drugs. Silver Spring, MD: FDA, 2008. Approval of generic drugs.
3. European Medicines Agency (EMA). Questions and answers on generic medicines. Canary Wharf: EMA, 2011.
4. World Health Organization (WHO). WHO drug information. Vol. 28, No. 1. Geneva: WHO, 2014. Available at: https://www.who.int/medicines/publications/druginformation/DI_28-1_web.pdf?ua=1. Accessed: 21.06.2015.
5. Cameron A, Mantel-Teeuwisse AK, Leufkens HGM, Laing RO. Switching from originator brand medicines to generic equivalents in selected developing countries: how much could be saved? Value Health. 2012;15(5):664-73. DOI:10.1016/j.jval.2012.04.004
6. Dunne S, Shannon B, Dunne C, Cullen W. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study. BMC Pharmacol Toxicol. 2013;14:1. DOI:10.1186/2050-6511-14-1
7. Dunne SS, Dunne CP. What do people really think of generic medicines? A systematic review and critical appraisal of literature on stakeholder perceptions of generic drugs. BMC Med. 2015;13:173. DOI:10.1186/s12916-015-0415-3
8. Dunne SS. What Do Users of Generic Medicines Think of Them? A systematic review of consumers’ and patients’ perceptions of, and experiences with, generic medicines. Patient. 2016;9(6):499-510. DOI:10.1007/s40271-016-0176-x
9. Colgan S, Faasse K, Martin LR, et al. Perceptions of generic medication in the general population, doctors and pharmacists: a systematic review. BMJ Open. 2015;5(12):e008915. DOI:10.1136/bmjopen-2015-008915
10. Kesselheim AS, Misono AS, Lee JL, et al. Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA. 2008;300(21):2514-26. DOI:10.1001/jama.2008.758
11. Manzoli L, Flacco ME, Boccia S, et al. Generic versus brand-name drugs used in cardiovascular diseases. Eur J Epidemiol. 2016;31(4):351-68. DOI:10.1007/s10654-015-0104-8
12. Leclerc J, Thibault M, Gonella JM, et al. Are generic drugs used in cardiology as effective and safe as their brand-name counterparts? A systematic review and meta-analysis. Drugs. 2020;80(7):697-710. DOI:10.1007/s40265-020-01296-x
13. Corrao G, Soranna D, Merlino L, Mancia G. Similarity between generic and brand-name antihypertensive drugs for primary prevention of cardiovascular disease: evidence from a large population-based study. Eur J Clin Invest. 2014;44(10):933-9. DOI:10.1111/eci.12326
14. Corrao G, Soranna D, La Vecchia C, et al. Medication persistence and the use of generic and brand-name blood pressure-lowering agents. J Hypertens. 2014;32(5):1146-53; discussion 1153. DOI:10.1097/HJH.0000000000000130
15. Desai RJ, Sarpatwari A, Dejene S, et al. Comparative effectiveness of generic and brand-name medication use: A database study of US health insurance claims. PLoS Med. 2019;16(3):e1002763. DOI:10.1371/journal.pmed.1002763
16. Zhang SY, Tao LY, Yang YY, et al. Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China. Chin Med J (Engl). 2021;134(3):292-301. DOI:10.1097/CM9.0000000000001360
17. Leclerc J, Blais C, Rochette L, et al. Impact of the Commercialization of three generic angiotensin II receptor blockers on adverse events in Quebec, Canada: a population-based time series analysis. Circ Cardiovasc Qual Outcomes. 2017;10(10):e003891. DOI:10.1161/CIRCOUTCOMES.117.003891
18. Leclerc J, Blais C, Rochette L, et al. Public health outcomes may differ after switching from brand-name to generic angiotensin II receptor blockers. Drugs R D. 2020;20(2):135-45. DOI:10.1007/s40268-020-00307-2
19. Tian Y, Reichardt B, Dunkler D, et al. Comparative effectiveness of branded vs. generic versions of antihypertensive, lipid-lowering and hypoglycemic substances: a population-wide cohort study. Sci Rep. 2020;10(1):5964. DOI:10.1038/s41598-020-62318-y
20. Hansen RA, Qian J, Berg R, et al. Comparison of generic-to-brand switchback rates between generic and authorized generic drugs. Pharmacotherapy. 2017;37(4):429-37. DOI:10.1002/phar.1908
21. Desai RJ, Sarpatwari A, Dejene S, et al. Differences in rates of switchbacks after switching from branded to authorized generic and branded to generic drug products: cohort study. BMJ. 2018;361:k1180. DOI:10.1136/bmj.k1180
22. Dentali F, Donadini MP, Clark N, et al. Brand name versus generic warfarin: a systematic review of the literature. Pharmacotherapy. 2011;31(4):386-93. DOI:10.1592/phco.31.4.386
23. Leclerc J, Blais C, Rochette L, et al. Trends in hospital visits for generic and brand-name warfarin users in Québec, Canada; a population-based time series analysis. Am J Cardiovasc Drugs. 2019;19(3):287-97. DOI:10.1007/s40256-018-0309-9
24. Caldeira D, Fernandes RM, Costa J, et al. Branded versus generic clopidogrel in cardiovascular diseases: a systematic review. J Cardiovasc Pharmacol. 2013;61(4):277-82. DOI:10.1097/FJC.0b013e31827e5c60
25. Ko DT, Krumholz HM, Tu JV, et al. Clinical outcomes of Plavix and generic clopidogrel for patients hospitalized with an acute coronary syndrome. Circ Cardiovasc Qual Outcomes. 2018;11(3):e004194. DOI:10.1161/CIRCOUTCOMES.117.004194
26. Corrao G, Soranna D, Arfè A, et al. Are generic and brand-name statins clinically equivalent? Evidence from a real data-base. Eur J Intern Med. 2014;25(8):745-50. DOI:10.1016/j.ejim.2014.08.002
27. Jackevicius CA, Tu JV, Krumholz HM, et al. Comparative effectiveness of generic Atorvastatin and Lipitor® in patients hospitalized with an acute coronary syndrome. J Am Heart Assoc. 2016;5(4):e003350. DOI:10.1161/JAHA.116.003350
28. Sicras-Mainar A, Sánchez-Álvarez L, Navarro-Artieda R, Darbà J. Treatment persistence and adherence and their consequences on patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain: a retrospective cost-consequences analysis. Lipids Health Dis. 2018;17(1):277. DOI:10.1186/s12944-018-0918-y
29. Gagne JJ, Choudhry NK, Kesselheim AS, et al. Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study. Ann Intern Med. 2014;161(6):400-7. DOI:10.7326/M13-2942
30. Roth GA, Mensah GA, Johnson CO, et al.; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 Study. JACC. 2020;76(25):2982-3021. DOI:10.1016/j.jacc.2020.11.010
31. Aitken M, Kleinrock M. Global medicines use in 2020: outlook and implications. USA: Parsippany, New Jersey, 2015.
________________________________________________
1. World Health Organization (WHO). Generic drugs. Geneva: WHO, 2015.
2. US Food and Drug Administration (FDA). Generic drugs. Silver Spring, MD: FDA, 2008. Approval of generic drugs.
3. European Medicines Agency (EMA). Questions and answers on generic medicines. Canary Wharf: EMA, 2011.
4. World Health Organization (WHO). WHO drug information. Vol. 28, No. 1. Geneva: WHO, 2014. Available at: https://www.who.int/medicines/publications/druginformation/DI_28-1_web.pdf?ua=1. Accessed: 21.06.2015.
5. Cameron A, Mantel-Teeuwisse AK, Leufkens HGM, Laing RO. Switching from originator brand medicines to generic equivalents in selected developing countries: how much could be saved? Value Health. 2012;15(5):664-73. DOI:10.1016/j.jval.2012.04.004
6. Dunne S, Shannon B, Dunne C, Cullen W. A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with usage of generic medicines, using Ireland as a case study. BMC Pharmacol Toxicol. 2013;14:1. DOI:10.1186/2050-6511-14-1
7. Dunne SS, Dunne CP. What do people really think of generic medicines? A systematic review and critical appraisal of literature on stakeholder perceptions of generic drugs. BMC Med. 2015;13:173. DOI:10.1186/s12916-015-0415-3
8. Dunne SS. What Do Users of Generic Medicines Think of Them? A systematic review of consumers’ and patients’ perceptions of, and experiences with, generic medicines. Patient. 2016;9(6):499-510. DOI:10.1007/s40271-016-0176-x
9. Colgan S, Faasse K, Martin LR, et al. Perceptions of generic medication in the general population, doctors and pharmacists: a systematic review. BMJ Open. 2015;5(12):e008915. DOI:10.1136/bmjopen-2015-008915
10. Kesselheim AS, Misono AS, Lee JL, et al. Clinical equivalence of generic and brand-name drugs used in cardiovascular disease: a systematic review and meta-analysis. JAMA. 2008;300(21):2514-26. DOI:10.1001/jama.2008.758
11. Manzoli L, Flacco ME, Boccia S, et al. Generic versus brand-name drugs used in cardiovascular diseases. Eur J Epidemiol. 2016;31(4):351-68. DOI:10.1007/s10654-015-0104-8
12. Leclerc J, Thibault M, Gonella JM, et al. Are generic drugs used in cardiology as effective and safe as their brand-name counterparts? A systematic review and meta-analysis. Drugs. 2020;80(7):697-710. DOI:10.1007/s40265-020-01296-x
13. Corrao G, Soranna D, Merlino L, Mancia G. Similarity between generic and brand-name antihypertensive drugs for primary prevention of cardiovascular disease: evidence from a large population-based study. Eur J Clin Invest. 2014;44(10):933-9. DOI:10.1111/eci.12326
14. Corrao G, Soranna D, La Vecchia C, et al. Medication persistence and the use of generic and brand-name blood pressure-lowering agents. J Hypertens. 2014;32(5):1146-53; discussion 1153. DOI:10.1097/HJH.0000000000000130
15. Desai RJ, Sarpatwari A, Dejene S, et al. Comparative effectiveness of generic and brand-name medication use: A database study of US health insurance claims. PLoS Med. 2019;16(3):e1002763. DOI:10.1371/journal.pmed.1002763
16. Zhang SY, Tao LY, Yang YY, et al. Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China. Chin Med J (Engl). 2021;134(3):292-301. DOI:10.1097/CM9.0000000000001360
17. Leclerc J, Blais C, Rochette L, et al. Impact of the Commercialization of three generic angiotensin II receptor blockers on adverse events in Quebec, Canada: a population-based time series analysis. Circ Cardiovasc Qual Outcomes. 2017;10(10):e003891. DOI:10.1161/CIRCOUTCOMES.117.003891
18. Leclerc J, Blais C, Rochette L, et al. Public health outcomes may differ after switching from brand-name to generic angiotensin II receptor blockers. Drugs R D. 2020;20(2):135-45. DOI:10.1007/s40268-020-00307-2
19. Tian Y, Reichardt B, Dunkler D, et al. Comparative effectiveness of branded vs. generic versions of antihypertensive, lipid-lowering and hypoglycemic substances: a population-wide cohort study. Sci Rep. 2020;10(1):5964. DOI:10.1038/s41598-020-62318-y
20. Hansen RA, Qian J, Berg R, et al. Comparison of generic-to-brand switchback rates between generic and authorized generic drugs. Pharmacotherapy. 2017;37(4):429-37. DOI:10.1002/phar.1908
21. Desai RJ, Sarpatwari A, Dejene S, et al. Differences in rates of switchbacks after switching from branded to authorized generic and branded to generic drug products: cohort study. BMJ. 2018;361:k1180. DOI:10.1136/bmj.k1180
22. Dentali F, Donadini MP, Clark N, et al. Brand name versus generic warfarin: a systematic review of the literature. Pharmacotherapy. 2011;31(4):386-93. DOI:10.1592/phco.31.4.386
23. Leclerc J, Blais C, Rochette L, et al. Trends in hospital visits for generic and brand-name warfarin users in Québec, Canada; a population-based time series analysis. Am J Cardiovasc Drugs. 2019;19(3):287-97. DOI:10.1007/s40256-018-0309-9
24. Caldeira D, Fernandes RM, Costa J, et al. Branded versus generic clopidogrel in cardiovascular diseases: a systematic review. J Cardiovasc Pharmacol. 2013;61(4):277-82. DOI:10.1097/FJC.0b013e31827e5c60
25. Ko DT, Krumholz HM, Tu JV, et al. Clinical outcomes of Plavix and generic clopidogrel for patients hospitalized with an acute coronary syndrome. Circ Cardiovasc Qual Outcomes. 2018;11(3):e004194. DOI:10.1161/CIRCOUTCOMES.117.004194
26. Corrao G, Soranna D, Arfè A, et al. Are generic and brand-name statins clinically equivalent? Evidence from a real data-base. Eur J Intern Med. 2014;25(8):745-50. DOI:10.1016/j.ejim.2014.08.002
27. Jackevicius CA, Tu JV, Krumholz HM, et al. Comparative effectiveness of generic Atorvastatin and Lipitor® in patients hospitalized with an acute coronary syndrome. J Am Heart Assoc. 2016;5(4):e003350. DOI:10.1161/JAHA.116.003350
28. Sicras-Mainar A, Sánchez-Álvarez L, Navarro-Artieda R, Darbà J. Treatment persistence and adherence and their consequences on patient outcomes of generic versus brand-name statins routinely used to treat high cholesterol levels in Spain: a retrospective cost-consequences analysis. Lipids Health Dis. 2018;17(1):277. DOI:10.1186/s12944-018-0918-y
29. Gagne JJ, Choudhry NK, Kesselheim AS, et al. Comparative effectiveness of generic and brand-name statins on patient outcomes: a cohort study. Ann Intern Med. 2014;161(6):400-7. DOI:10.7326/M13-2942
30. Roth GA, Mensah GA, Johnson CO, et al.; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 Study. JACC. 2020;76(25):2982-3021. DOI:10.1016/j.jacc.2020.11.010
31. Aitken M, Kleinrock M. Global medicines use in 2020: outlook and implications. USA: Parsippany, New Jersey, 2015.
Авторы
М.В. Леонова*
Межрегиональная общественная организация «Ассоциация клинических фармакологов», Москва, Россия
*anti23@mail.ru
________________________________________________
Marina V. Leonova*
Interregional Public Organization “Association of Clinical Pharmacologists”, Moscow, Russia
*anti23@mail.ru