Comparing tolerability and efficacy of generic versus brand alendronate: a
randomized clinical study in postmenopausal women with a recent fracture.
Author(s): van den Bergh JP(1), Bouts ME, van der Veer E, van der Velde RY, Janssen MJ,
Geusens PP, Winkens B, Oldenhof NJ, van Geel TA.
Affiliation(s): Author information:
(1)Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo,
The Netherlands ; Department of Internal Medicine, Maastricht University Medical
Centre, Maastricht, The Netherlands ; Maastricht University, NUTRIM - School for
Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands ; Biomedical
Research Centre, University Hasselt, Diepenbeek, Belgium.
Publication date & source: 2013, PLoS One. , 8(10):e78153
INTRODUCTION: An increasing number of generic alendronate formulations have
become available. Although expected to have the same tolerability and efficacy,
head-to head comparison of generic and brand alendronate was never performed.
Therefore, we compared the tolerability and efficacy of generic and brand
alendronate.
METHODS: In a randomized double-blinded single centre cross-over study in 37
postmenopausal women (mean age 65.4±6.4 years) with osteoporosis were treated
with generic and branded alendronate during 24 (2x12) weeks. Tolerance was
evaluated by the Gastro intestinal Symptom Rating Scale (GSRS) and self-reported
side effects. Efficacy was assessed by serum bone turnover markers, carboxy
terminal telopeptide (CTX) and procollagen type I N-terminal propeptide (PINP).
No wash out period was allowed (ethical reasons). Because of possible carry over
effect only data of the first 12 weeks were analyzed using linear mixed models.
RESULTS: There were no significant differences in overall tolerance (GSRS)
between treatment groups. However, for subscale abdominal pain, patients using
generic had a significantly higher mean GSRS score at week 4 (estimated mean
difference (B): 0.40; 95%CI: 0.05 to 0.74, p = 0.024). The level of bone turnover
markers significantly decreased over 12 weeks of follow-up for generic and
branded alendronate (p < 0.001). Mean level of CTX was significantly lower with
branded at week 4 (B: 121.3; 95%CI: 52.0 to 190.5), but not at week 12 (B: 53.6;
95%CI:-3.7 to 110.9). No significant differences were found for PINP at week 4 or
12.
CONCLUSIONS: Bone turnover markers were significantly reduced with branded and
generic alendronate. With branded, CTX was significantly lower at 4 weeks.
Generic caused significantly higher abdominal pain scores in the first 4 weeks of
treatment. Therefore, generic alendronate may not have the same tolerability and
efficacy as branded alendronate in the first weeks after starting treatment in
patients with a recent fracture.
TRIAL REGISTRATION: Dutch Trial Register NTR number 1867
http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1867.
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