Journal Article

Suicide-related risk among patients using branded and generic fluoxetine: a propensity score-matched, new‐user design in Taiwan

Zheng, Cong-Wei, Wen, Yuan-Liang, Huang, Yu-Chieh, To, Sheng-Yin, Kao, Li-Ting, Yang, Hui-Wen

2024

Overview

Background To date, the clinical equivalence between branded and generic medications remains debate and may sometimes be a reason why psychiatrists are hesitant to prescribe generic medications. Depression is recognized to exacerbate suicide risk globally and selective serotonin reuptake inhibitors, such as fluoxetine are common treatment options. Therefore, this study aimed to explores differences in suicidal risks between users of branded and generic fluoxetine in Taiwan. Methods This cohort study used Taiwan Longitudinal Health Insurance Database, encompassing 2 million individuals covered by National Health Insurance (NHI) program. The full cohort consisted of 32,298 fluoxetine new users. Then, 7,380 branded and 7,380 propensity score matched (PSM) generic fluoxetine new users were identified. The study further utilized Cox proportional hazards models to assess risk of 5-year suicidal ideation, suicide mortality, and all-cause mortality. Results The study revealed that the adjusted hazard ratios (HRs) for suicidal ideation, suicide mortality and all-cause mortality in branded users were 0.766 (95% CI, 0.497 − 1.181), 0.660 (95% CI, 0.447 − 0.975), and 0.942 (95% CI, 0.849 − 1.045), respectively, when compared with matched generic fluoxetine users. Stratified and sensitivity analyses showed the lower risk of suicide mortality in specific subgroups, such as male (adjusted HRs = 0.536, 95% CI = 0.306–0.939) and young branded users (adjusted HRs = 0.549, 95% CI = 0.334–0.904). Conclusion This study observed trends in the prevention effects of suicide-related risks. However, only suicide mortality was statistically significant, especially in males and those aged < 40 years. These insights may assist clinicians and policymakers in decision-making. Clinical trial number NA (This study is a cohort study utilizing the national health insurance database, not a clinical trial).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Aged / Antidepressants / Bioavailability / Bioequivalence / Bipolar disorder / Branded / Cohort analysis / Cohort Studies / Comparative analysis / Complications and side effects / Confounding (Statistics) / Decision making / Depression / Diabetes / Dosage and administration / Drug therapy / Drugs, Generic - therapeutic use / FDA approval / Female / Fluoxetine / Fluoxetine - therapeutic use / Generic / Generic drugs / Humans / Hyperlipidemia / Hypertension / Major depressive disorder / Male / Medicine / Medicine & Public Health / Middle Aged / Mortality / Patient outcomes / Patients / Postpartum depression / Prescription drugs / Prevention / Propensity Score / Proportional Hazards Models / Proprietary drugs / Psychiatry / Psychotherapy / Psychotropic drugs / Risk factors / Schizophrenia / Selective serotonin reuptake inhibitors / Selective Serotonin Reuptake Inhibitors - therapeutic use / Sensitivity analysis / Serotonin uptake inhibitors / Sex differences / Sleep disorders / Statistical analysis / Suicidal behavior / Suicidal Ideation / Suicide / Suicide - statistics & numerical data / Suicides & suicide attempts / Taiwan / Young Adult