Clinical Tolerability of Generic vs. Brand Beta Blockers in Heart Failure with Reduced Left Ventricular Ejection Fraction: A Retrospective Cohort from Heart Failure Clinic

Abstract

Background: Beta blockers have been shown to decrease mortality and morbidity in Heart Failure Reduced Ejection Fraction (HFrEF) patients. However, the side effects are also dose-related leading to the underdosing. Cost constraint may be one of limitations of appropriate beta blocker used which can be improved with generic drug. However, the effects in real life practice have not been investigated. Methods and results: This study aimed to compare the efficacy and safety of generic and brand beta blockers in HFrEF patients. We performed a retrospective cohort analysis in HFrEF patients who received either generic or brand beta blocker in Chiang Mai Heart Failure Clinic. The primary endpoint was the proportions of patients received at least 50% target dose of beta blocker between generic and brand beta blockers. Adverse events were secondary endpoints. 217 patients (119 and 98 patients receiving generic and brand beta blocker respectively) were enrolled. There were no differences between groups regarding age, gender, etiology of heart failure, NYHA class, LVEF, rate of receiving ACEI, ARB or spironolactone. Patients receiving brand beta blocker had less resting heart rate at baseline (74.9 and 84.2 bpm, p=0.001). Rate of achieved 50% target dose and target daily dose did not differ between groups (40.4 vs. 44.5% and 48.0 vs. 55.0%, p>0.05 respectively). Rate of side effects was not different between groups (32.3 vs. 29.5%, p>0.05) and most common side effect was hypotension. Conclusion: This study demonstrated that beta blocker tolerability was comparable between brands and generic. Generic or brand beta blockers should be prescribed to HFrEF patients without contraindication.