1. In this observational trial, generic statins were associated with better adherence rates and clinical outcomes compared to brand-name statins.
Evidence Rating Level: 2 (Good)
Study Rundown: Statins are one of the most commonly prescribed medications in the United States. However, it remains unclear how brand-name statins may differ from generic statins in clinical practice. This observational study found that those who took generic statins, when compared to brand-name statins, showed a greater adherence to the therapy. Furthermore, those on generic statins were associated with a small, but statistically significant, decrease in the risk of hospitalization for acute coronary syndrome (ACS). The greatest strength of this trial is its inclusion of over 90,000 patients. A major limitation was the potentially confounding effects in the different populations that took brand-name statins versus generic statins. For example, patients that took brand-name statins were more likely to be white, male, and have a higher income. Overall, this study suggests that brand-name statins are not superior to generic statins, and may be associated with worse adherence rates and clinical outcomes.
In-Depth [systematic review]: Among the 90,111 patients included in this study, 93% initiated a generic statin and 7% initiated a brand-name statin. Simvastatin was the most commonly prescribed statin. To assess adherence, the proportion of days covered (PDC) of each group was measured. A statistically significant difference in PDC was noted between the two groups: 77% in the generic group and 71% for the brand-name group. Hospitalization for ACS was the only outcome found to be significantly decreased in the generic group, with a matched hazard ratio of 0.92 [CI=0.85-0.99]. Additionally, the composite endpoint, which included cardiovascular events and death, was also found to be significantly lower in the generic group with an absolute decrease of 1.53 events per 100-person-years. Although this observational study is limited by possible confounding factors, the correlation between PDC and outcomes illustrates the potential importance of improving patient adherence to prevent cardiovascular events.
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