Therapy discontinuation or substitution in patients with cardiovascular disease, switching among different products of the same off-patent active substance: a 'real-world' retrospective cohort study.
The present study investigated the effects of switching to different products of the same off-patent active substance (brand name or generic) on therapy discontinuation or substitution with another molecule of the same class, in patients with cardiovascular disease treated with statins and antihypertensives in a 'real-world' setting.



A retrospective cohort study in a 'real-world' setting.



Analysis of data performed by integrating administrative databases that included approximately two million individuals who are assisted by the National Health System from three Local Health Units located in three different regions of Italy.



All patients aged ≥18 years with at least one prescription of simvastatin, ramipril or amlodipine in the period 1 January to 31 December 2010 were included and followed up for 2 years.



Prescription refills occurring during follow-up were evaluated. Frequency of discontinuation of therapy or substitution with another molecule of the same class (eg, from simvastatin to a different statin) during follow-up was identified.



During follow-up, therapy discontinuation or substitution was found to be more frequent in patients switching to a different product of the same active substance compared with non-switching patients (11.5% vs 10.8% and 22.2% vs 20.8% (p=0.002), respectively, in the simvastatin group; 4.0% vs 3.5% and 24.6% vs 22.7% (p<0.001), respectively, in the amlodipine group). In the ramipril group, 8% of patients undertook a therapy substitution to another molecule; no trend towards a lower percentage of substitution was observed in the non-switching group, while 18% of patients discontinued treatment, with a significant difference in favour of patients not switching. These findings were partially confirmed by multivariate analysis.



Switches among products of the same active substance are quite common in patients with cardiovascular disease. Our study suggests that switching may expose patients to a higher risk of therapy discontinuation or substitution.
CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.
Luca
L
Degli Esposti
CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.
Diego
D
Sangiorgi
CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.
Stefano
S
Buda
CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy.
Ezio
E
Degli Esposti
Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.
Francesco
F
Scaglione
D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D016208:Databases, Factual; D057915:Drug Substitution / Q000009:adverse effects / Q000706:statistics & numerical data*; D016568:Drugs, Generic / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017257:Ramipril / Q000627:therapeutic use; D012189:Retrospective Studies; D019821:Simvastatin / Q000627:therapeutic use; D016903:Drug Monitoring
D000959:Antihypertensive Agents; D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017311:Amlodipine; D019821:Simvastatin; D017257:Ramipril
Adherence to treatment; Amlodipine; Ramipril; Simvastatin; Switching