Key result
The 2018 valsartan recall drives switching to other ARBs while overall ARB usage remains unchanged.
Why the study?
The impact of nitrosamine recalls on valsartan, losartan, and irbesartan usage and switching patterns across multiple countries was unclear.
Cohort (n=17,000,000)
Yes
The 2018 nitrosamine recalls of ARBs caused significant disruptions in prescribing patterns, notably a steep decline in valsartan use and switching to other ARBs in North America, highlighting regional differences in recall impact.
Answers are grounded in this paper and cite their sources.
Stable overall ARB use despite recall-driven shifts suggests resilient supply; leaves open effects on adherence and outcomes.
OBJECTIVES: To examine valsartan, losartan and irbesartan usage and switching patterns in the USA, UK, Canada and Denmark before and after July 2018, when the first Angiotensin-Receptor-Blocker (ARB) (valsartan) was recalled. DESIGN: Retrospective cohort study. SETTING: USA, Canadian administrative healthcare data, Danish National Prescription Registry and UK primary care electronic health records. PARTICIPANTS: Patients aged 18 years and older between January 2014 and December 2020. INTERVENTION: Valsartan, losartan and irbesartan. MAIN OUTCOME: Monthly percentages of individual ARB episodes, new users and switches to another ARB, ACE inhibitors (ACEI) or calcium channel blockers containing products. RESULTS: We identified 10.8, 3.2, 1.8 and 1.2 million ARB users in the USA, UK, Canada and Denmark, respectively. Overall proportions of valsartan, losartan and irbesartan use were 18.4%, 67.9% and 5.2% in the USA; 3.1%, 48.3% and 10.2% in the UK, 16.3%, 11.4% and 18.3% in Canada, 1%, 93.5% and 0.6% in Denmark. In July 2018, we observed an immediate steep decline in the proportion of valsartan use in the USA and Canada. A similar trend was observed in Denmark; however, the decline was only minimal. We observed no change in trends of ARB use in the UK. Accompanying the valsartan decline was an increase in switching to other ARBs in the USA, Canada and Denmark. There was a small increase in switching to ACEI relative to the valsartan-to-other-ARBs switch. We also observed increased switching from other affected ARBs, losartan and irbesartan, to other ARBs throughout 2019, in the USA and Canada, although the usage trends in the USA remained unchanged. CONCLUSION: The first recall notice for valsartan resulted in substantial decline in usage due to increased switching to other ARBs. Subsequent notices for losartan and irbesartan were also associated with increased switching around the time of the recall, however, overall usage trends remained unchanged.
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Eworuke et al. (2023) conducted a cohort in Angiotensin-Receptor-Blocker (ARB) users (n=17,000,000). Valsartan, losartan and irbesartan was evaluated on Monthly percentages of individual ARB episodes, new users and switches to another ARB, ACE inhibitors (ACEI) or calcium channel blockers containing products. The 2018 valsartan recall resulted in a substantial decline in its usage and increased switching to other ARBs in the USA, Canada, and Denmark, while overall ARB usage trends remained unchanged.
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