Generieke substitutie en therapietrouw

Generic substitution is an important instrument to decrease the costs of pharmaceuticals. The aim of this comment is to describe potential concerns of generic substitution: the absence of bioequivalence, confusion leading to overdose, and non-adherence. In this paper, the focus is placed on the consequences for adherence. Two studies were identified that studied the association between generic substitution and adherence. A study from the USA demonstrated that there is no substantial difference in adherence between patients that initiate chronic treatment with generic drugs compared to brand drugs. A Dutch study showed that there is no difference in adherence between substituted and non-substituted users of brand antihypertensive drugs. In addition, there were no differences in cardiovascular hospitalizations. Although more research is needed, it seems justified to conclude that there is currently no evidence that the use of generic drugs leads to a decrease in adherence or an increase in hospitalizations. Thus, with adequate patient education, generic substitution remains an important instrument to decrease the costs of pharmaceutical care.