Divalproex sodium vs. valproic acid: drug utilization patterns, persistence rates and predictors of hospitalization among VA patients diagnosed with bipolar disorder

Abstract

The study showed a comparable profile of generic valproic acid with divalproex sodium for persistence and predictors of hospitalization for bipolar patients on monotherapy in the VA. Results have important healthcare implications for treatment and costs.

Switching from Brand‐Name to Generic Psychotropic Medications: A Literature Review

“…Authors concluded that generic valproic acid could be safely used in this population and may lead to considerable monetary savings. Iqbal et al [31] compared 4036 patients with bipolar disorder on branded divalproex sodium monotherapy to 588 patients with bipolar disorder on generic valproic acid monotherapy in a retrospective study using Veterans Affairs databases. They found no significant differences in persistence with medication, risk of hospitalization and time to event between the two groups.…”

Valproate, divalproex, valpromide: Are the differences in indications justified?

“…Two studies retrospectively analysed medical records of individuals newly treated with either DVP or VA. No difference in efficacy was found after analysing the records of 300 individuals (n = 150 for VA and n = 150 for DVP), but several different psychiatric disorders were involved, not equally distributed between groups [46]. Another analysis of 18-month data of 4264 individuals treated as monotherapy (n = 588 with DVP and n = 4036 for VA) found no difference in terms of hospitalization risk for bipolar disorder, time to hospitalization and time to switch of therapy [35]. However, individuals were included following a period under treatment without symptoms or side effects.…”

“…Some included only individuals treated for bipolar or other mood disorders [38,42,45], while others also included individuals treated for behavioural disorders [41,45,46]. Studies comparing efficacy in these conditions had three different methodologies: before/after (prospective or retrospective) comparisons of switching individuals from DVP to VA [41,42,45], retrospective cohort analyses of individuals on either DVP or VA [35,46] and a single parallel prospective comparative study [38]. Criteria for determining efficacy were the Clinical Global Impression (CGI) or a derivative score [41,42,46], the rate of switch or interruption of therapy specifically for lack of efficacy [45,46] or the length of hospitalization or the rate of rehospitalization [35,41,45].…”

“…Studies comparing efficacy in these conditions had three different methodologies: before/after (prospective or retrospective) comparisons of switching individuals from DVP to VA [41,42,45], retrospective cohort analyses of individuals on either DVP or VA [35,46] and a single parallel prospective comparative study [38]. Criteria for determining efficacy were the Clinical Global Impression (CGI) or a derivative score [41,42,46], the rate of switch or interruption of therapy specifically for lack of efficacy [45,46] or the length of hospitalization or the rate of rehospitalization [35,41,45]. Only one study used the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HRSD) score [38].…”

Valproate: do formulations matter?

“…In the retrospective cohort study by Iqbal et al. (1) that compared the utilization of valproic acid with divalproex sodium among outpatients with bipolar disorder receiving care in the Veterans Affairs healthcare system, persistence rates for the two different formulations of valproate did not differ. Moreover, no advantage was observed for the more expensive divalproex sodium in terms of time to hospitalization.…”