title: Burden of changes in pill appearance for patients receiving generic cardiovascular medications after myocardial infarction: cohort and nested case-control studies.
abstract: BACKGROUND
  Generic prescription drugs made by different manufacturers may vary in color or shape, and switching among these drug products may interrupt medication use.
  
  
  OBJECTIVE
  To determine whether nonpersistent use of generic drugs among patients with cardiovascular disease after myocardial infarction (MI) is associated with inconsistent appearance of their medications.
  
  
  METHODS
  Cohort and nested case-control studies.
  
  
  METHODS
  Claims from a commercial health insurance database in the United States.
  
  
  METHODS
  Patients discharged after hospitalization for MI between 2006 and 2011 who initiated treatment with a generic β-blocker, angiotensin-converting enzyme inhibitor, angiotensin II-receptor blocker, or statin. Case patients discontinued their index medication for at least 1 month; control patients continued treatment. Control patients were matched to case patients on therapeutic class, number of dispensings before nonpersistence, sex, and age.
  
  
  METHODS
  Rates of changes in pill color and shape during the year after MI were calculated. Next, 2 refills preceding nonpersistence were evaluated to determine whether pill color or shape had changed. Odds of discordance among case and control patients were compared using conditional logistic regression.
  
  
  RESULTS
  A total of 29% of patients (3286 of 11,513) had a change in pill shape or color during the study. Statins had the most changes in appearance, whereas β-blockers had the fewest. A total of 4573 episodes of nonpersistence was matched to 19,881 control episodes. The odds of nonpersistence in case patients increased by 34% after a change in pill color (adjusted odds ratio, 1.34 [95% CI, 1.12 to 1.59]) and 66% after a change in pill shape (adjusted odds ratio, 1.66 [CI, 1.43 to 1.94]).
  
  
  CONCLUSIONS
  Only 3 categories of drugs indicated after MI were evaluated, and clinical outcomes were not addressed.
  
  
  CONCLUSIONS
  Variation in the appearance of generic pills is associated with nonpersistent use of these essential drugs after MI among patients with cardiovascular disease.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality and the Harvard Program in Therapeutic Science.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Kesselheim
authors.forename: Katsiaryna
authors.initials: K
authors.lastname: Bykov
authors.forename: Jerry
authors.initials: J
authors.lastname: Avorn
authors.forename: Angela
authors.initials: A
authors.lastname: Tong
authors.forename: Michael
authors.initials: M
authors.lastname: Doherty
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D016568:Drugs, Generic; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D009203:Myocardial Infarction / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors