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How to solve the problem of drug choice within the same class from the standpoint of evidence-based medicine?

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The question of the possibility of the most effective drug choosing within one class from the standpoint of evidence-based medicine is considered in the article. Drugs belonging to the same class may have both great similarities and significant differences. This is demonstrated by the example of different classes of drugs (beta-blockers, angiotensin-converting enzyme inhibitors, and new oral anticoagulants). The choice of the most effective (from the standpoint of evidence-based medicine) is impossible if there are no direct comparisons in randomized controlled studies between drugs of the same class that have demonstrated their effectiveness separately. Analysis of observational studies (large databases, registers) to identify the most effective drug in a class cannot be used to solve the problem of the superiority of a drug within a class.

About the Author

S. Yu. Martsevich
National Medical Research Center for Preventive Medicine
Russian Federation

Sergey Yu. Martsevich - MD, PhD, Professor, Head of Preventive Pharmacotherapy Department.

Petroverigsky per. 1 0, Moscow, 101990


1. Collins R., MacMahon M. Reliable assessment of the effects of treatment on mortality and major morbidity, I: clinical trials. Lancet. 2001;357:373-80. doi:10.1016/S0140-6736(00)03651-5.

2. Rational pharmacotherapy of patients with cardiovascular diseases. Russian guidelines. Cardiovascular Therapy and Prevention. 2009;8(6) suppl 4:1-56 (In Russ)

3. Soares I., Carneiro A.V. Drug class effects: definitions and practical applications. Rev Port Cardiol. 2002;21:783-95.

4. Furberg C.D., Pitt B. Are All Angiotensin-Converting Enzyme Inhibitors Interchangeable? J Am Coll Cardiol. 2001;37:1 456-60. doi:10.1016/S0735-1097(01)01161-5.

5. Pocock S.J., Stone G.W. The Primary Outcome Fails - What Next? N Engl J Med. 2016;375:861 -70. doi :10.1056/NEJMra1510064.

6. Martsevich S.Yu., Kutishenko N.P., Tolpygina S.N., et al. Efficacy and safety of drug therapy in primary and secondary prevention of cardiovascular diseases. RSSC Guidelines, 2011. Rational Pharmacotherapy in Cardiology 2011 ;7(5) suppl:1 -72 (In Russ.) doi:10.20996/1819-64462011-7-5.

7. O'Gara P.T., Kushner F.G., Ascheim D.D., et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61 (4):e78-140. doi:10.1016/j.jacc.2012.11.019.

8. Pedersen T.R., Faergeman O., Kastelein J.J., et al.; Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) Study Group. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA. 2005;294(19):2437-45. doi:10.1001/jama.294.19.2437.

9. Connolly S.J., Ezekowitz M.D., Yusuf S., et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(1 2):1 1 39-51. doi:10.1056/NEJMoa0905561.

10. Patel M.R., Mahaffey K.W., Garg J., et al. Riva roxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011 ;365(10):883-891. doi:10.1056/NEJMoa1009638.

11. Granger C.B., Alexander J.H., McMurray J.J.V., et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011 ;365(1 1 ):981 -92. doi:10.1056/NEJMoa1107039.

12. Martsevich S.Y, Kutishenko N.P. Randomised Clinical Trials and Observational Studies: the Ratio in the Hierarchy of Evidence of the Efficacy of Drugs. Rational Pharmacotherapy in Cardiology 2016;1 2(5):567-73. (In Russ.) doi:10.20996/1819-6446-2016-12-5-567-573.

13. . Camm J., Fox K., Peterson E. Challenges in comparing the non-vitamin K antagonist oral anticoagulants for atrial fibrillation-related stroke prevention. Europace. 2018;20(1 ):1-11. doi:10.1093/eu-ropace/eux086.

14. Harris M., Taylor G., Jackson D. Clinical Evidence Made Easy: The Basics of Evidence-Based Medicine. Banbury, UK: Scion Publishing Limited; 2014.

15. Bakhai A., Patel S., Wang D. Blinding. In: Wang D., Bakhai A., eds. Clinical trials. A practical guide to design, analysis, and reporting. London, UK: Remedica; 2006: 75-87.

16. Wang D., Bakhai A., eds. Clinical trials. A practical guide to design, analysis and reporting. London, UK: Remedica; 2006.

17. Al-Lamee R., Thompson D., Dehbi H.M. et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018;391 (1 01 1 5):31 -40. doi:10.1016/S0140-6736(17)32714-9.

18. Acharjee S., Teo K.K., Jacobs A.K., et al. Optimal medical therapy with or without percutaneous coronary intervention in women with stable coronary disease: A pre-specified subset analysis of the Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial. Am Heart J. 2016;1 73:108-17. doi:10.1016/j.ahj.2015.07.020.

19. Martsevich S.Yu., Navasardyan A.R., Zakharova N.A., Lukyanov M.M. New oral anticoagulants: can the results of international controlled studies with these drugs be transferred to Russian patients? Cardiovascular Therapy and Prevention. 2015;14:48-52 (In Russ.) doi :10.15829/1728-8800-2015-5-48-52.

20. Andrade J.G., Krahn A.D., Skanes A.C., et al. Values and preferences of physicians and patients with nonvalvular atrial fibrillation who receive oral anticoagulation therapy for stroke prevention. Can J Cardiol. 2016;32(6):747-53. doi:10.1016/j.cjca.2015.09.023.

21. Camm A.J., Amarenco P., Hess S., et al. XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation. Eur Heart J. 2016;37:1 145-53. doi: 10.1093/eurheartj/ehv466.

22. Larsen T.B., Skjoth F, Nielsen P.B., et al. Comparative effectiveness and safety of non-vitamin K antagonists oral anticoagulants and warfarin in patients with atrial fibrillation: propensity weighted cohort study. BMJ. 2016;353:i3189.

23. Collaborative meta-analysis or randomized trials of antiplatalet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ. 2002;324:71-86. doi:10.1136/bmj.324.7329.71.

For citation:

Martsevich S.Yu. How to solve the problem of drug choice within the same class from the standpoint of evidence-based medicine? Rational Pharmacotherapy in Cardiology. 2019;15(2):271-276. (In Russ.)

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)