Burden of Changes in Pill Appearance for Patients Receiving Generic Cardiovascular Medications After Myocardial Infarction Cohort and Nested Case-Control Studies
Burden of Changes in Pill Appearance for Patients Receiving Generic Cardiovascular Medications After Myocardial Infarction Cohort and Nested Case-Control Studies
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DOI：
10.7326/m13-2381
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发表时间：
2014-07-15
影响因子：
39.2
通讯作者：
Choudhry, Niteesh K.
中科院分区：
文献类型：
--
作者：
Kesselheim, Aaron S.;Bykov, Katsiaryna;Choudhry, Niteesh K.
背景资料：不同厂家生产的仿制处方药可能在颜色或形状上有所不同，在这些药品之间切换可能会中断药物使用。目的：确定心肌梗死（MI）后心血管疾病患者非持续使用仿制药是否与其药物外观不一致有关。设计：队列和巢式病例对照研究。设置：患者：2006年至2011年期间因MI住院后出院，开始接受通用β受体阻滞剂、血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂或他汀类药物治疗的患者。病例患者停用索引药物至少1个月;对照患者继续治疗。对照组患者与病例组患者在治疗类别、非持久性、性别和年龄前的配药数量相匹配：计算MI后一年内药丸颜色和形状的变化率。接下来，评价非持久性之前的2次再填充，以确定药丸颜色或形状是否发生变化。病例组和对照组患者之间的不一致性的几率进行了比较，使用条件Logistic regulation.Results：共29%的患者（3286 11 513）在研究期间药丸形状或颜色的变化。他汀类药物的外观变化最大，而β受体阻滞剂的变化最少。共有4573次非持续性发作与19881次对照发作相匹配。改变药丸颜色后，病例患者的非持续性几率增加了34（调整后的比值比，1.34 [95% CI，1.12至1.59]），改变药丸形状后为66%（调整的比值比，1.66 [CI，1.43至1.94]）。局限性：仅对MI后适用的3类药物进行了评价，未涉及临床结局。心血管疾病患者MI后非持续使用这些基本药物与仿制药外观的变化有关疾病
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.Design: Cohort and nested case-control studies.Setting: Claims from a commercial health insurance database in the United States.Patients: Patients discharged after hospitalization for MI between 2006 and 2011 who initiated treatment with a generic beta-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.Measurements: 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 beta-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]).Limitation: Only 3 categories of drugs indicated after MI were evaluated, and clinical outcomes were not addressed.Conclusion: Variation in the appearance of generic pills is associated with nonpersistent use of these essential drugs after MI among patients with cardiovascular disease.