Study Supports Comparable Efficacy of Generic and Brand-Name Drugs for Chronic Conditions

A recent study provides evidence that the use of generic medications for chronic conditions is associated with comparable clinical outcomes to the use of brand-name products.
Although generic versions of prescription medications can be a cheaper alternative for patients, many perceive generics as less effective and less safe than their brand-name counterparts.
The study, published in PLOS Medicine, evaluated comparative outcomes between the use of generics versus brand-name drugs in patients with chronic conditions, such as diabetes, hypertension, osteoporosis, and depression and anxiety. The researchers used authorized generics (AGs) as the control group to mitigate negative perception bias because AGs are identical in chemical composition and appearance to brand-name drugs but are marketed as generics.
For the analysis, the researchers used data from 2 large US commercial databases of more than 3.5 million patients. The following groups were compared: 
  1. Patients switching from brand-name products to AGs versus generics, and patients initiating treatment with AGs versus generics, where AG use proxied brand-name use.
  2. Patients initiating generics versus brand-name products and patients initiating AG versus brand-name products.
The study examined 8 products: amlodipine, amlodipine/benazepril, quinapril, alendronate, calcitonin, sertraline, escitalopram, and glipizide. When compared with brand-name products, the generic products for alendronate and calcitonin, glipizide, and quinapril showed no differences in clinical outcomes. According to the data, a lower risk of the composite cardiovascular endpoint was observed with generics versus brand-name products for amlodipine and amlodipine/benazepril (hazard ratio [HR] 0.91; 95% CI, 0.84–0.99 and HR 0.84; 95% CI 0.76–0.94, respectively).
Out of the 16 clinical endpoints analyzed, only 4 were associated with different outcomes, according to the study. Three favored generics and 1 favored switching from brand-name amlodipine to the AG.
The researchers did find higher rates of psychiatric hospitalization for patients taking generic and AG escitalopram and sertraline (HR 1.05; 95% CI, 1.01–1.10 and HR 1.07; 95% CI, 1.01–1.14, respectively), compared with those who initiated the brand-name product. They noted that these outcomes were likely due to either residual confounding or generic perception bias.
Despite the rising use of generic medications, negative perceptions still hold some patients back from using the alternative and cheaper drug option. Switching back to the brand-name product when less expensive generic versions are available can contribute to unnecessary costs to the patient and the health care system, according to the study authors.
“These results may inform clinical practice by guiding the development of educational interventions to address physicians’ and patients’ negative perceptions of generics and to increase awareness regarding the equivalence of generic and brand-name drugs,” the researchers wrote in the study.
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 Medicine. 2019.

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