A users' guide to understanding therapeutic substitutions |
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| Affiliation: | 1. Faculty of Health Sciences, University of Ottawa, 43 Templeton Street, Ottawa, Canada K1N6X1;2. Centre for Clinical Epidemiology and Evaluation (C2E2), University of British Columbia, 828 West 10th Ave, Research Pavilion, Vancouver, Canada, V5Z 1M9;3. College of Pharmacy, Faculty of Health Professions, Dalhousie University, 5968 College St, Halifax, Nova Scotia, Canada, B3H 4R2;4. Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, Canada, L8S 4K1;5. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, CH-4031, Basel, Switzerland;6. Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, Ontario, Canada, K1Y 4E9 |
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| Abstract: | Therapeutic substitutions are common at the level of ministries of health, clinicians, and pharmacy dispensaries. Guidance in determining whether drugs offer similar risk–benefit profiles is limited. Those making decisions on therapeutic substitutions should be aware of potential biases that make differentiating therapeutic agents difficult. Readers should consider whether the biological mechanisms and doses are similar across agents, whether the evidence is sufficiently valid across agents, and whether the safety and therapeutic effects of each drug are similar. This article uses a problem-based format to address the biological mechanism, validity, and results of a scenario in which therapeutic substitutions may be considered. |
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| Keywords: | Therapeutic substitutions Class effects Network meta-analysis Generic substitutions Statins Evidence-based medicine |
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