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To the Editor:
We read with interest the article by Duh et al.,1 who investigated the clinical and economic consequences following the generic substitution of one vs multiple generics of topiramate. Using a database comprising pharmacy and medical claims, the authors concluded that many generic substitutions of topiramate were associated with negative outcomes including hospitalizations, fracture injuries, and overall health care costs.
We feel the thrust to use brand name drugs even for conditions which have a narrow therapeutic index such as epilepsy is predominantly industry driven. We also note that this article is industry supported. Physicians are consistently reminded by industry representatives that generics are somehow less potent than brand name drugs and that seizure control frequently deteriorates when a patient is switched to a generic. Our experience points to the contrary.
The majority of patients who are switched to a generic version either due to treating doctor or patient preferences experience no change in their seizure frequency or side-effect profile. Generic versions have to meet the same Food and Drug Administration standards of bioequivalence as the brand name …
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