Use of Fibrates in the United States and Canada

Abstract

Context Interest in the role of fibrates has intensified with the publication of the negative ACCORD trial with fenofibrate, especially since the evidence for clinical outcomes benefit for fibrates is heavily weighted on older fibrates, gemfibrozil and clofibrate. Objective This study seeks to examine trends in the current use of fibrates, and for fenofibrate, to illuminate the relationship between differences in the availability of proprietary versus generic formulations and use and economic implications in the United States (US) compared with Canada. Design/Setting/Patients Population-level, cohort study using IMS Health data in the United States and Canada of patients prescribed fibrates between 2002 and 2009. Main Outcome Measure(s) Fibrate prescribing and expenditures. Results From 2002–2009, fibrate prescriptions increased 117.1% in the US, by 12,000/month to 2.1 million prescriptions/month, yet only increased by 18.1% in Canada. (p<0.001) Fenofibrate use was relatively constant in Canada, while in the US, it increased by 159.3%, comprising 47.9% of total fibrate prescriptions in 2002 and 65.2% in 2009. The annual ratio of generic:brand fenofibrate use in the US from 2002 to 2008 ranged from 0:1 to 0.09:1, while the ratio in Canada steadily increased from 2005 to 2008 from 0.51:1 to 1.89:1. In the US, crude fenofibrate expenditures rose from $33.2 million/month in 2002 to $129.6 million/month in 2009, while those in Canada declined from $5.6 million/month to $5.1 million/month. Fibrate expenditures per 100,000 population were 3-fold higher in the US compared with Canada in 2009. Conclusions During the past decade, prescriptions for fibrates, particularly, fenofibrate, increased in the United States, while prescriptions for fibrates in Canada remained stable.

National Trends in Nonstatin Use and Expenditures Among the US Adult Population From 2002 to 2013: Insights From Medical Expenditure Panel Survey

“…However, we found in our study that 1.3 million (1.1%) adults without ASCVD reported cholesterol absorption inhibitors used (6 million prescriptions) in 2012‐2013, resulting in ≈$3.3 billion in annual expenditures, even before the publication of IMPROVE‐IT. Within the context of the lack of evidence supporting favorable outcomes, the significant national expenditures of almost $17.9 billion ($4.7 billion direct out‐of‐pocket costs) between 2002 and 2013 on niacin and fenofibrates, highlight the need for outcome evidence to guide approval and adoption of future drugs to avoid risk of significant economic waste 19, 20…”

Novel Use of a Lipid-Lowering Fibrate Medication to Prevent Nicotine Reward and Relapse: Preclinical Findings

“…Clofibrate was chosen to represent this class of medications in this study, but a number of fibrate medications are in clinical use, comprising almost 1% of all prescriptions in the United States (Jackevicius et al, 2011). All of these drugs (fenofibrate, gemfibrozil, bezafibrate, and ciprofibrate) selectively Figure 7 Clofibrate blocked nicotine-induced elevations of extracellular dopamine in the nucleus accumbens shell.…”

“…Although none of the treatment drugs in these previous studies have been approved for human use, there is a class of medications, the fibrates, that directly activate PPARa and have been used for decades to prevent cardiovascular disease and other complications associated with abnormal lipid profiles (Jackevicius et al, 2011;Abourbih et al, 2009). If fibrate medications can block the addiction-related effects of nicotine in humans, the fact that they are already in clinical use could streamline their adoption as aids to smoking cessation.…”

The Effect of Competing Direct-to-Consumer Advertising Campaigns on the Use of Drugs for Benign Prostatic Hyperplasia: Time Series Analysis

“…27 This database estimates national prescription activity at retail, mail-order, long-term care, and managed care outlets based on a sample of 70 % of all outlets. 28,29 As both drugs are predominantly prescribed at fixed dosage strengths, we examined changes in the number of units sold. Monthly rates of units dispensed were obtained for tamsulosin and dutasteride for the periods from January 2003 through December 2007 in order to ensure a 36-month window around the start of each DTCA campaign.…”