Evidence map›Paper›PMID 27098970›Full record

Observational studyJournal of the American Heart Association2016

Comparative Effectiveness of Generic Atorvastatin and Lipitor® in Patients Hospitalized with an Acute Coronary Syndrome.

Cynthia A Jackevicius, Jack V Tu, Harlan M Krumholz, Peter C Austin, Joseph S Ross, Therese A Stukel, Maria Koh, Alice Chong, Dennis T Ko

Open access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of the American Heart Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 2 pooled it
18.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.

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  14. BrandJournal of the Royal Statistical Society. Series A, (Statistics in Society) · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 2 countries.

Cynthia A JackeviciusDepartment of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA Institute for Clinical Evaluative Sciences, Toronto Ontario, Canada Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto Ontario, Canada Division of Cardiology, Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto Ontario, Canada cjackevicius@westernu.edu.
Jack V TuInstitute for Clinical Evaluative Sciences, Toronto Ontario, Canada Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto Ontario, Canada University Health Network, Toronto, Ontario, Canada.
Harlan M KrumholzSection of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, CT Yale University School of Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University, New Haven, CT Robert Wood Johnson Clinical Scholars Program, New Haven, CT.
Peter C AustinInstitute for Clinical Evaluative Sciences, Toronto Ontario, Canada Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto Ontario, Canada.
Joseph S RossYale University School of Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT Section of General Internal Medicine, Department of Medicine, Yale University, New Haven, CT.
Therese A StukelInstitute for Clinical Evaluative Sciences, Toronto Ontario, Canada Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto Ontario, Canada.
Maria KohInstitute for Clinical Evaluative Sciences, Toronto Ontario, Canada.
Alice ChongInstitute for Clinical Evaluative Sciences, Toronto Ontario, Canada.
Dennis T KoInstitute for Clinical Evaluative Sciences, Toronto Ontario, Canada Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto Ontario, Canada University Health Network, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences · CASunnybrook Health Science Centre · CAVA Greater Los Angeles Healthcare System · USYale New Haven Hospital · USYale University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAlthough generic medications are approved based on bioequivalence with brand-name medications, there remains substantial concern regarding their clinical effectiveness and safety. Lipitor(®), available as generic atorvastatin, is one of the most commonly prescribed statins. Therefore, we compared the effectiveness of generic atorvastatin products and Lipitor(®). METHODS AND

resultsWe conducted a population-based cohort study, using propensity score matching to minimize potential confounding of patients ≥65 years, discharged alive after acute coronary syndrome (ACS) hospitalization between 2008 and 2012 in Ontario, Canada, who were prescribed Lipitor(®) or generic atorvastatin within 7 days of discharge. The primary outcome was 1-year death/recurrent ACS hospitalization. Secondary outcomes included hospitalization for heart failure, stroke, new-onset diabetes, rhabdomyolysis, and renal failure. In the 7863 propensity-matched pairs (15 726 patients), mean age was 76.9 years, 56.3% were male, 87.6% had myocardial infarction, and all patients had complete follow-up. At 1 year, 17.7% of those prescribed generic atorvastatin and 17.7% of those prescribed Lipitor(®) experienced death or recurrent ACS (hazard ratio, 1.00; 95% CI, 0.93-1.08; P=0.94). No significant differences in rates of secondary outcomes between groups were observed. Prespecified subgroup analyses by age, sex, diabetes, atorvastatin dose, or admission diagnosis found no outcome difference between groups.

conclusionsAmong older adults discharged alive after ACS hospitalization, we found no significant difference in cardiovascular outcomes or serious, infrequent side effects in patients prescribed generic atorvastatin compared with those prescribed Lipitor(®) at 1 year. Our findings support the use of generic atorvastatin in ACS, which could lead to substantial cost saving for patients and health care plans without diminishing population clinical effectiveness.

Indexed as

Acute Coronary SyndromeAgedAtorvastatinComparative Effectiveness ResearchDrugs, GenericFemaleHospitalizationHumansMalePropensity ScoreTreatment OutcomeAtorvastatinDrugs, Genericacute coronary syndromecomparative effectivenessstatin

Identifiers

PMID27098970
PMCPMC4859299
OpenAlexW2337792578

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.