GIs Say OTC Generics Effective, But Still Recommend Brand Name Laxatives and PPIs

Although gastroenterologists believe store brand products are as effective as their brand name counterparts, many still recommend the brand name products.

When recommending OTC laxatives and proton pump inhibitors (PPIs), most gastroenterologists tend to suggest brand name products rather than cheaper store brand products.

According to 2 studies conducted by researchers from the University of Michigan Health System, the recommendations come despite physicians acknowledging the effectiveness and equivalence of OTC generic laxatives and PPIs. In addition, many participants were not aware of the cost savings that can be realized by using store brand products.

Researchers presented both studies during Digestive Diseases Week in Chicago on May 3, 2014.

“At a time when doctors are highly constrained in their use of prescription medicines for so-called lifestyle conditions like GERD and constipation, treatment of these conditions is going to shift more and more to the OTC space,” study author William D. Chey, MD, said in a University of Michigan Health System press release. “As a result, it will become important for doctors to reflect on their OTC treatment recommendations.”

Generics manufacturer Perrigo Company plc provided funding for the study, the release stated.

For the study on OTC laxatives, researchers mailed a 14-question survey to 3600 randomly selected American Gastroenterological Association (AGA) member gastroenterologists. Approximately 23% returned the survey, researchers stated. Although most survey participants—95%—used OTC remedies as first-line treatment, most gastroenterologists directed their patients toward brand name therapies rather than store brand remedies. According to the results, only 40% of participants said they recommended store brands to patients all of the time or very often.

The recommendations of brand name fiber supplements, osmotics, and stool softeners were given despite the fact that 90% of participants felt that brand name and store brand laxatives were equally effective. The demographic data collected during the survey showed that participants who were in practice for more than 20 years were more likely to recommend store brand products than those who had not practiced as long. In addition, researchers found that many participants tended to underestimate the cost savings associated with store brand laxatives.

For the study on OTC GERD medications, researchers mailed a 22-question survey to 3600 randomly selected AGA member gastroenterologists, and received 830 responses. Half of participants recommended OTC PPIs to their patients, whereas 33% recommended prescription PPIs and 13% recommended an OTC H₂-receptor antagonist.

Of participants, 72% felt store brand PPIs and branded PPIs were bioequivalent, and 76% felt that store brand PPIs were as effective as their brand name counterparts. Half of participants recommended brand name products to patients more than 30% of the time, however. Less than one-third of participants knew the cost savings that could be realized by using the less expensive store brand products, researchers added.

In addition, more than half of participants said they had no knowledge of the generic approval process. More than 80% reported receiving no education about store brand treatments during residency or fellowship training.

Similar to the OTC laxative research, the study authors found that clinicians in practice for more than 20 years were more likely to recommend store brand products. Academic gastroenterologists were less likely to recommend store brand PPIs than their non-academic counterparts, researchers noted.