Beta-Blockers: All-for-One or One-for-All?

Alvin B. Lin, MD, FAAFP
 
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.

Given a choice, most health plans will recommend a generic medication over a similar but branded one. Of course, one has to remember that prior to the medication being made available as a generic, it was once sold only under a brand name. In general, each pharmaceutical company wants to differentiate its me-too drug from everyone else's in the same drug class. But those who handle the purse strings would like us to believe in class effect over drug effect, that they're all the same, & replaceable.

Well, in a meta-analysis published online earlier this month in the American Journal of Cardiology, the authors compared carvedilol, a beta-blocker, to other beta-1 selective beta-blockers (atenolol, bisoprolol, metprolol & nebivolol) and concluded that carvedilol was better at lowering all-cause mortality in patients suffering from heart failure.

The problem with this meta-analysis is that it's a meta-analysis. It's not a direct comparison of each drug to its competitors. This type of drug comparison study is rarely published because it's rarely funded & performed. After all, which pharmaceutical company wants to take the chance that their already cleared & marketed drug will lose to a competitor? So you have to leave it to the government to fund this type of study OR you look at the existing literature and run some tricky statistics.

Will I change my prescribing habits based upon a single study, especially a meta-analysis? Probably not. At least not until we find more of a trend as opposed to a possible fluke. As always, discuss your concerns with your prescribing physician before stopping any medication.