Abstract
To explore long-term changes in intra and inter-class choices between generic compounds, this paper investigates the market trends of two antihypertensive drug classes that have closely related pharmacological mechanisms—angiotensin convertase enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We analysed the development of ACEI and ARB markets between 2001 and 2016 in nine European countries, covering the genericization transition periods of both therapeutic groups. The analysis was undertaken on the level of the active pharmaceutical ingredients (API) and focused on international and country-specific diffusion patterns. Comparison of ARB and ACEI therapies shows that although ARBs became off-patent during the observed period, and have a clinical advantage in terms of the adverse event profile over ACEIs, the increasing dominance of ARBs cannot be identified. One explanation is that ACEI therapies became generics earlier, relocating competition to the level of brands, while competition among ARBs remained at the level of the APIs. As for intra-class drug preferences, it was observed that the long-term trends show that ramipril outperformed its ACEI competitors, even though the kinetics and the rank order of preferred active compounds were inconsistent among markets. The diffusion of clinically preferable therapies seems to be ultimately supported by generic entries. In Eastern European countries, the emergence of generic markets has not only improved access to ACE inhibitors and ARBs, but has been a prerequisite for changing preferences. In contrast, genericization resulted in the relative anchoring of prior, branded era-based preferences in some Western European countries, which may be attributed to the role of the cessation of promotion and the fixity of prescription behaviour.
Highlights
One explanation is that angiotensin convertase enzyme inhibitors (ACEIs) therapies became generics earlier, relocating competition to the level of brands, while competition among angiotensin receptor blockers (ARBs) remained at the level of the active pharmaceutical ingredients (API)
As for intra-class drug preferences, it was observed that the long-term trends show that ramipril outperformed its ACEI competitors, even though the kinetics and the rank order of preferred active compounds were inconsistent among markets
Genericization resulted in the relative anchoring of prior, branded era-based preferences in some Western European countries, which may be attributed to the role of the cessation of promotion and the fixity of prescription behaviour
Summary
When choosing a therapy, physicians select the option that ensures the best outcome for patients. In the article from 2017, Kovács and Simon analysed the effect of clinical evidence and price on prescription drug sales, hypothesizing that generic markets favour those drug classes or active moieties from direct competitors that represent the highest therapeutic value. Their assumption, based on EBM principles, was that an absolute clinical ranking (Appendix A, Figure A1) can be defined based on the clinical differences among the active ingredients used in the same indication [5]. Can international or country-specific interrelationships be identified based on longterm prescribing trends?
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