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Kengne AP, Brière JB, Le Nouveau P, Kodjamanova P, Atanasov P, Kochoedo M, Irfan O, Khan ZM. Impact of single-pill combinations versus free-equivalent combinations on adherence and persistence in patients with hypertension and dyslipidemia: a systematic literature review and meta-analysis. Expert Rev Pharmacoecon Outcomes Res 2024; 24:817-827. [PMID: 38088763 DOI: 10.1080/14737167.2023.2293199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVES Hypertension is a leading cause of death and disease burden followed by dyslipidemia. Their asymptomatic nature leads to low adherence and persistence to treatments. A systematic literature review (SLR) investigated the impact of single-pill-combinations (SPC) compared to free-equivalent combination (FEC) on adherence, persistence, clinical outcomes, healthcare resource utilization (HCRU), and patient-reported outcomes, in patients with hypertension, dyslipidemia, or both. METHODS MEDLINE, MEDLINE-IN-PROCESS, Embase, and Cochrane were searched from inception until 11 May 2021, for studies comparing SPC against FEC in patients with hypertension and/or dyslipidemia. Patient characteristics, study design, therapies, measures of adherence or persistence, clinical outcomes, and follow-up were extracted. RESULTS Among 52 studies identified in the SLR, 27 (n = 346,030 patients) were included in the meta-analysis. SPCs were associated with significantly improved adherence compared with FEC, as assessed through medication-possession-ratio ≥80% (odds ratio (OR) 0.42, p < 0.01) and proportion of days covered ≥80% (OR 0.45, p < 0.01). SPC also improved persistence (OR 0.44, p < 0.01) and systolic blood pressure (SBP) reduction (mean difference -1.50, p < 0.01) compared with the FEC. CONCLUSIONS SPC use resulted in significantly improved adherence, persistence, and SBP levels compared with FEC in patients with hypertension. The findings support SPC use in reducing the burden of hypertension and dyslipidemia.
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Affiliation(s)
- André Pascal Kengne
- A Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Petar Atanasov
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Maryse Kochoedo
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
| | - Omar Irfan
- Health Economics and Market Access, Amaris Consulting, Toronto, Canada
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2
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Leblay L, Bélanger A, Desjardins C, Filiatrault M, Paquette JS, Drouin-Chartier JP. Relationship Between Diet Quality and Antihypertensive Medication Intensity Among Adults With Metabolic Syndrome-Associated High Blood Pressure. CJC Open 2024; 6:30-39. [PMID: 38313343 PMCID: PMC10837706 DOI: 10.1016/j.cjco.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 02/06/2024] Open
Abstract
Background Management of high blood pressure (BP), a key feature of the metabolic syndrome (MetS), relies on diet and medication. Whether these modalities are used as complements has never been evaluated in real-world settings. This study assessed the relationship between diet quality and antihypertensive medication intensity among adults with MetS-associated high BP. Methods This cross-sectional study included 915 adults with MetS-associated high BP from the CARTaGENE cohort (Québec, Canada), of whom 677 reported using BP-lowering medication. Antihypertensive medication intensity was graded per the number of BP-lowering classes used simultaneously. Diet quality was assessed using the Dietary Approach to Stop Hypertension (DASH) score. Results No evidence of a relationship between antihypertensive medication intensity and diet quality was found (β for each additional antihypertensive = -0.05; 95% CI, -0.35; 0.26 DASH score points). However, among men aged < 50 years and women aged < 60 years, the DASH score was inversely associated with medication intensity (β = -0.72; 95% CI, -1.24, -0.19), whereas this relationship tended to be positive among older participants (β = 0.32; 95% CI, -0.05, 0.69). Among participants with low Framingham risk score, the DASH score was inversely associated with medication intensity (β = -0.70; 95% CI, -1.31, -0.09), but no evidence of an association was found among individuals at moderate (β = 0.00; 95% CI, -0.45, 0.45) or high (β = 0.30, 95% CI, -0.24, 0.84) risk. Conclusions In this cohort of adults with MetS-associated high BP, there was an overall lack of complementarity between diet quality and BP-lowering medication, especially among younger individuals and those with a lower risk for cardiovascular disease for whom diet quality was inversely associated with intensity of medication.
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Affiliation(s)
- Lise Leblay
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Amélie Bélanger
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Clémence Desjardins
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Mathieu Filiatrault
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
| | - Jean-Sébastien Paquette
- Département de médecine familiale et de médecine d'urgence, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
- VITAM, Centre de recherche en santé durable, Université Laval, Québec City, Québec, Canada
- Centre Hospitalier Régionale de Lanaudière, Saint-Charles-Borromée, Québec City, Québec, Canada
| | - Jean-Philippe Drouin-Chartier
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, Québec, Canada
- Faculté de Pharmacie, Université Laval, Québec City, Québec, Canada
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3
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Mancia G, Cappuccio FP, Burnier M, Coca A, Persu A, Borghi C, Kreutz R, Sanner B. Perspectives on improving blood pressure control to reduce the clinical and economic burden of hypertension. J Intern Med 2023; 294:251-268. [PMID: 37401044 DOI: 10.1111/joim.13678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.
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Affiliation(s)
- G Mancia
- University of Milano-Bicocca, Milan, Italy
| | - F P Cappuccio
- University of Warwick, Warwick Medical School, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - M Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - A Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - C Borghi
- Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy
| | - R Kreutz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - B Sanner
- Department of Internal Medicine, Agaplesion Bethesda, Wuppertal, Germany
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4
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Wei Q, Zhou J, Li H, Wang L, Wu Y, Ma A, Guan X. Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis. Front Pharmacol 2023; 14:1156081. [PMID: 37033611 PMCID: PMC10074603 DOI: 10.3389/fphar.2023.1156081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Objective: We conducted a large-scale meta-analysis and subgroup analysis to compare the effect of fixed-dose combination (FDC) therapy with that of free-equivalent combination (FEC) therapy on medication adherence. Methods: Studies published in Web of Science, PubMed, Cochrane Library, ScienceDirect, and Embase up to May 2022 were identified according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary assessed outcomes were the medication possession ratio (MPR) and proportion of days covered (PDC). We investigated the probability of being adherent to the prescribed treatment (MPR or PDC ≥80%) or the average estimate of these two parameters. Studies reporting such results were included in this meta-analysis. The summary measures were reported as the risk ratio (RR) and the weighted mean difference (MD) with 95% of confidence interval (CI) using the random-effects model of DerSimonian and Laird. The quality of the cohort studies was assessed using the Newcastle-Ottawa scale. Results: Of the 1,814 screened studies, 61 met the predefined inclusion criteria. The meta-analysis of the results showed that compared to FEC, FDC significantly improved the medication compliance of patients by 1.29 times (95% CI:1.23-1.35, p < 0.00001). I2 of 99% represent high heterogeneity across studies. The mean difference in medication adherence between FDC and FEC was 0.10 (95% CI: 0.06-0.14, p < 0.00001) with an I2 estimate of 100%. Subgroup analyses were performed for studies that reported adherence outcomes according to disease type, period of evaluation and compliance indicators. A sensitivity analysis was conducted to exclude the results of low-quality studies, as well as studies in which there was ambiguity in the method of calculating the estimator. Conclusion: Analysis of the assessed parameters for the intention-to-treat and subgroup populations suggests that FDC can improve adherence to treatment and its advantages over FEC may increase over time. Further research is needed to better understand how medical conditions affect the impact of reduced pill burden on adherence, particularly in diseases other than cardiovascular disease and type 2 diabetes mellitus.
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Affiliation(s)
- Qiran Wei
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Jiting Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Hongchao Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Luying Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Yao Wu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
- *Correspondence: Aixia Ma, ; Xin Guan,
| | - Xin Guan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
- Center for Pharmacoeconomics and Outcomes Research of China Pharmaceutical University, Nanjing, Jiangsu, China
- *Correspondence: Aixia Ma, ; Xin Guan,
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Povetkin SV, Kornilov AA. [Pharmacotherapy optimization opportunities using fixed combinations in patients with high cardiovascular risk]. KARDIOLOGIIA 2022; 62:63-69. [PMID: 35834344 DOI: 10.18087/cardio.2022.6.n2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/08/2022] [Indexed: 06/15/2023]
Abstract
This review focuses on the role of arterial hypertension and hyperlipidemia as the most important risk factors of early disability and death. The facts are provided that many persons with those risk factors do not have the adequate control of blood pressure and atherogenic fractions of blood serum lipoproteins. The review addresses prospects for optimizing pharmacotherapy with fixed combinations of drugs for arterial hypertension and dyslipidemia. From the perspective of effective clinical guidelines and the available evidence base, the authors reviewed possibilities for improving the treatment compliance by using combinations of antihypertensive and hypolipidemic drugs in a single dosage form. Implementation of such complex, optimized treatment using a three-component fixed-dose combination is considered.
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Jafar TH, Tan NC, Shirore RM, Allen JC, Finkelstein EA, Hwang SW, Koong AYL, Moey PKS, Kang GCY, Goh CWT, Subramanian RC, Thiagarajah AG, Ramakrishnan C, Lim CW, Liu J. Integration of a multicomponent intervention for hypertension into primary healthcare services in Singapore-A cluster randomized controlled trial. PLoS Med 2022; 19:e1004026. [PMID: 35696440 PMCID: PMC9239484 DOI: 10.1371/journal.pmed.1004026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/28/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite availability of clinical practice guidelines for hypertension management, blood pressure (BP) control remains sub-optimal (<30%) even in high-income countries. This study aims to assess the effectiveness of a potentially scalable multicomponent intervention integrated into primary care system compared to usual care on BP control. METHODS AND FINDINGS A cluster-randomized controlled trial was conducted in 8 government clinics in Singapore. The trial enrolled 916 patients aged ≥40 years with uncontrolled hypertension (systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg). Multicomponent intervention consisted of physician training in risk-based treatment of hypertension, subsidized losartan-HCTZ single-pill combination (SPC) medications, nurse training in motivational conversations (MCs), and telephone follow-ups. Usual care (controls) comprised of routine care in the clinics, no MC or telephone follow-ups, and no subsidy on SPCs. The primary outcome was mean SBP at 24 months' post-baseline. Four clinics (447 patients) were randomized to intervention and 4 (469) to usual care. Patient enrolment commenced in January 2017, and follow-up was during December 2018 to September 2020. Analysis used intention-to-treat principles. The primary outcome was SBP at 24 months. BP at baseline, 12 and 24 months was modeled at the patient level in a likelihood-based, linear mixed model repeated measures analysis with treatment group, follow-up, treatment group × follow-up interaction as fixed effects, and random cluster (clinic) effects. A total of 766 (83.6%) patients completed 2-year follow-up. A total of 63 (14.1%) and 87 (18.6%) patients in intervention and in usual care, respectively, were lost to follow-up. At 24 months, the adjusted mean SBP was significantly lower in the intervention group compared to usual care (-3.3 mmHg; 95% CI: -6.34, -0.32; p = 0.03). The intervention led to higher BP control (odds ratio 1.51; 95% CI: 1.10, 2.09; p = 0.01), lower odds of high (>20%) 10-year cardiovascular risk score (OR 0.67; 95% CI: 0.47, 0.97; p = 0.03), and lower mean log albuminuria (-0.22; 95% CI: -0.41, -0.02; p = 0.03). Mean DBP, mortality rates, and serious adverse events including hospitalizations were not different between groups. The main limitation was no masking in the trial. CONCLUSIONS A multicomponent intervention consisting of physicians trained in risk-based treatment, subsidized SPC medications, nurse-delivered motivational conversation, and telephone follow-ups improved BP control and lowered cardiovascular risk. Wide-scale implementation of a multicomponent intervention such as the one in our trial is likely to reduce hypertension-related morbidity and mortality globally. TRIAL REGISTRATION Trial Registration: Clinicaltrials.gov NCT02972619.
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Affiliation(s)
- Tazeen Hasan Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Durham, North Carolina, United States of America
- * E-mail:
| | | | | | - John Carson Allen
- Center for Quantitative Medicine, Office of Research, Duke-NUS Medical School, Singapore
| | | | | | | | | | | | | | | | | | | | - Ching Wee Lim
- Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore
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Wilke T, Weisser B, Predel HG, Schmieder RE, Wassmann S, Gillessen A, Blettenberg J, Maywald U, Randerath O, Müller S, Böhm M. Effects of cardiovascular single pill combinations compared with identical multi-pill therapies on healthcare cost and utilization in Germany. J Comp Eff Res 2022; 11:411-422. [PMID: 35315281 DOI: 10.2217/cer-2021-0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study assessed whether a single pill combination (SPC) is associated with lower direct healthcare costs. Materials & methods: Anonymized claims data of patients ≥18 years treated with drugs for cardiovascular (CV)-related diseases either as a single pill combination or multi-pill combination (follow-up to 1 year) were evaluated. After propensity score matching, 59,336 out of 1,369,840 patients were analyzed. Results: In all cohorts, patients receiving a single pill combination had a lower frequency of general practitioner and specialist visits. The patients also had a significantly lower ratio of all-cause hospitalization days and number of CV-related prescriptions as well as all-cause prescriptions (with one exception) compared with those receiving a multi-pill combination. Conclusion: Direct CV-related costs were significantly lower in four out of seven comparisons, with a trend toward lower costs in the other three comparisons.
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Affiliation(s)
- Thomas Wilke
- Institute for Pharmacoeconomics & drug logistics, University of Wismar, 23966, Germany
| | - Burkhard Weisser
- Institute of Sports Science, Christian-Albrechts-University of Kiel, Kiel, 24118, Germany
| | - Hans-Georg Predel
- Institute of Cardiology & Sports Medicine, German Sport University, Cologne, 50933, Germany
| | - Roland E Schmieder
- Department of Nephrology & Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg, Erlangen, 91054, Germany
| | - Sven Wassmann
- Department of Inner medicine & Cardiology, Cardiology Pasing, Munich, 81241, Germany & Faculty of Medicine, University of the Saarland, Homburg/Saar, 66123, Germany
| | - Anton Gillessen
- Department of Internal Medicine, Herz-Jesu-Hospital, Münster, 48165, Germany
| | | | - Ulf Maywald
- Drug department, AOK PLUS, Dresden, 01067, Germany
| | - Olaf Randerath
- Medical Department, APONTIS PHARMA Germany GmbH & Co. KG, Monheim, 40789, Germany
| | - Sabrina Müller
- Department of Real-World Evidence & Evidence Synthesis, Ingress-Health HWM GmbH, Wismar, 23966, Germany
| | - Michael Böhm
- Clinic for Internal Medicine III, University clinic of Saarlandes, Saarland University, Homburg/Saar, Germany
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8
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Wilke T, Weisser B, Predel HG, Schmieder R, Wassmann S, Gillessen A, Blettenberg J, Maywald U, Randerath O, Mueller S, Böhm M. Effects of Single Pill Combinations Compared to Identical Multi Pill Therapy on Outcomes in Hypertension, Dyslipidemia and Secondary Cardiovascular Prevention: The START-Study. Integr Blood Press Control 2022; 15:11-21. [PMID: 35250308 PMCID: PMC8893154 DOI: 10.2147/ibpc.s336324] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Current guidelines for the treatment of arterial hypertension (AH) or cardiovascular (CV) prevention recommend combination drug treatments with single pill combinations (SPC) to improve adherence to treatment. We aimed to assess whether the SPC concept is clinically superior to multi pill combination (MPC) with identical drugs. Methods and Results In an explorative study, we analyzed anonymized claims data sets of patients treated with CV drugs for hypertension and/or CV disorders who were insured by the German AOK PLUS statutory health fund covering 01/07/2012-30/06/2018. Patients at age ≥18 years who received either a SPC or MPC with identical drugs were followed for up to one year. A one to one propensity score matching (PSM) was applied within patient groups who started identical drug combinations, and results were reported as incidence rate ratios (IRRs) as well as hazard ratios (HRs). After PSM, data from 59,336 patients were analyzed. In 30 out of 56 IRR analyses, superiority of SPC over MPC was shown. In 5 out of 7 comparisons, the HR for the composite outcome of all-cause death and all-cause hospitalizations was in favor of the SPC regimen (SPC versus MPC): valsartan/amlodipine: HR=0.87 (95% CI: 0.84–0.91, p ≤ 0.001); candesartan/amlodipine: 0.77 (95% CI: 0.65–0.90, p = 0.001); valsartan/amlodipine/hydrochlorothiazide: HR=0.68 (95% CI: 0.61–0.74, p ≤ 0.001); ramipril/amlodipine: HR=0.80 (95% CI: 0.77–0.83, p ≤ 0.001); acetylsalicylic acid (ASA)/atorvastatin/ramipril: HR=0.64 (95% CI: 0.47–0.88, p = 0.005). Conclusion SPC regimens are associated with a lower incidence of CV events and lower all-cause mortality in clinical practice. SPC regimens should generally be preferred to improve patient’s prognosis.
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Affiliation(s)
- Thomas Wilke
- Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM)/Institute for Pharmacoeconomics and Pharmaceutical Logistics, Wismar, Germany
- Correspondence: Thomas Wilke, Institute of Pharmacoeconomics and Medication Logistics, University of Wismar, Alter Holzhafen 19, Wismar, 23966, Germany, Tel +4938417581014, Fax +4938417581011, Email
| | - Burkhard Weisser
- Institute of Sports Science, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Hans-Georg Predel
- Institute of Cardiology and Sports Medicine, German Sport University, Cologne, Germany
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg, Erlangen, Germany
| | - Sven Wassmann
- Faculty of Medicine, Cardiology Pasing, Munich and University of the Saarland, Homburg/Saar, Germany
| | - Anton Gillessen
- Department of Internal Medicine, Herz-Jesu-Hospital, Münster, Germany
| | | | - Ulf Maywald
- AOK PLUS – The Health Insurance for Sachsen und Thüringen; GB Medicines/Remedies, Dresden, Germany
| | - Olaf Randerath
- Medical Department, APONTIS PHARMA GmbH & Co.KG, Monheim, Germany
| | | | - Michael Böhm
- Clinic for Internal Medicine III, University Clinic of Saarland, Saarland University, Homburg/Saar, Germany
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9
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Choudhry NK, Kronish IM, Vongpatanasin W, Ferdinand KC, Pavlik VN, Egan BM, Schoenthaler A, Houston Miller N, Hyman DJ. Medication Adherence and Blood Pressure Control: A Scientific Statement From the American Heart Association. Hypertension 2022; 79:e1-e14. [PMID: 34615363 PMCID: PMC11485247 DOI: 10.1161/hyp.0000000000000203] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 01/09/2023]
Abstract
The widespread treatment of hypertension and resultant improvement in blood pressure have been major contributors to the dramatic age-specific decline in heart disease and stroke. Despite this progress, a persistent gap remains between stated public health targets and achieved blood pressure control rates. Many factors may be important contributors to the gap between population hypertension control goals and currently observed control levels. Among them is the extent to which patients adhere to prescribed treatment. The goal of this scientific statement is to summarize the current state of knowledge of the contribution of medication nonadherence to the national prevalence of poor blood pressure control, methods for measuring medication adherence and their associated challenges, risk factors for antihypertensive medication nonadherence, and strategies for improving adherence to antihypertensive medications at both the individual and health system levels.
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Razon N, Hessler D, Bibbins-Domingo K, Gottlieb L. How Hypertension Guidelines Address Social Determinants of Health: A Systematic Scoping Review. Med Care 2021; 59:1122-1129. [PMID: 34779795 PMCID: PMC8597925 DOI: 10.1097/mlr.0000000000001649] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient-level and community-level social and economic conditions impact hypertension risk and control. We examined adult hypertension management guidelines to explore whether and how existing guidelines refer to social care activities. OBJECTIVE The objective of this study was to explore how hypertension guidelines reference social care activities. RESEARCH DESIGN A systematic scoping review of clinical guidelines for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines published in the United States between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on nonpregnant adults with hypertension. We extracted instances where guidelines referred to social determinants of health (SDH) or social care activities. The primary outcome was how guidelines covered social care activities, defined using a framework adapted from the National Academies of Sciences, Engineering, and Medicine (NASEM). RESULTS Search terms yielded 126 guidelines. Thirty-six guidelines met the inclusion criteria. Of those, 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical practice based on social risk information. These recommendations often lacked specific guidance around how to directly address social risk factors or reduce the impact of these risks on hypertension management. When guidelines referred to specific social factors, patient financial security was the most common. Over time, hypertension guidelines have included more references to SDH. CONCLUSION Information about SDH is included in many hypertension guidelines, but few guidelines provide clear guidance for clinicians or health systems on how to identify and address social risk factors in the context of care delivery.
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Affiliation(s)
- Na'amah Razon
- Philip R. Lee Institute for Health Policy Studies & Family and Community Medicine
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11
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Renna N, Piskorz D, Stisman D, Martinez D, Lescano L, Vissani S, Espeche W, Marquez D, Parodi R, Naninni D, Baroni M, Llanos D, Martinez R, Barochinner J, Staffieri G, Lanas F, Velásquez M, Marin M, Williams B, Ennis I. Position statement on use of pharmacological combinations in a single pill for treatment of hypertension by Argentine Federation of Cardiology (FAC) and Argentine Society of Hypertension (SAHA). J Hum Hypertens 2021:10.1038/s41371-021-00557-w. [PMID: 34088992 DOI: 10.1038/s41371-021-00557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
The present document provides scientific evidence reviewed and analysed by a group of specialist clinicians in hypertension that aims to give an insight into a pharmacological strategy to improve blood pressure control. Evidence shows that most hypertensive patients will need at least two drugs to achieve blood pressure goals. There is ample evidence showing that treatment adherence is inversely related to the number of drugs taken. Observational studies show that use of drug combinations to initiate treatment reduces the time to reach the treatment goal and reduces CVD, especially with single pill combinations (SPCs). This work, based on recommendations of the Argentine Federation of Cardiology and Argentine Society of Hypertension as a reference, aims to review the more recent evidence on SPC, and to serve as guidelines for health professionals in their clinical practice and to the wider use of SPCs for the treatment of hypertension. Evidence from clinical trials on the effectiveness and adverse effects of using SPCs are provided. An analysis is also made of the main contributions of SPCs in special populations, e.g., elderly and diabetic patients, and its use in high risk and resistant hypertension. The effects of SPCs on hypertensive-mediated organ damage is also examined. Finally, we provide some aspects to consider when choosing treatments in the economic context of Latin-America for promoting the most efficient use of resources in a scarce environment and to provide quality information to decision makers to formulate safe, cost-effective, and patient-centered health policies. Finally, future perspectives and limitations in clinical practice are also discussed.
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Affiliation(s)
- Nicolás Renna
- Unit of Hypertension, Hospital Español de Mendoza. School of Medicine. National University of Cuyo. IMBECU-CONICET, Mendoza, Argentina.
| | - Daniel Piskorz
- Sanatorio Británico Cardiology Institute, Rosario, Argentina
| | - Diego Stisman
- Instituto de Cardiología, San Miguel de Tucumán, Tucumán, Argentina
| | | | - Ludmila Lescano
- Servicio de Cardiología Hospital San Bernardo, Salta, Argentina
| | - Sergio Vissani
- Centro de neurología y rehabilitación-CENYR, San Luis, Argentina
| | | | - Diego Marquez
- Servicio de Nefrología Hospital San Bernardo, Salta, Argentina
| | - Roberto Parodi
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Diego Naninni
- Instituto Especialidades de la Salud Rosario, Santa Fe, Argentina
| | | | - Daniel Llanos
- Consultorio de Cardiología Clínica e Hipertensión Arterial en CEDIT / Clínica Chapelco y Centro Médico Roca, San Martìn de los Andes, Neuquèn, Argentina
| | - Rocio Martinez
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Fernando Lanas
- Departamento de Medicina Interna y CIGES, Universidad de La Frontera, Temuco, Chile
| | - Mónica Velásquez
- Departamento de Especialidades Médicas. CIGES, Universidad de La Frontera, Temuco, Chile
| | - Marcos Marin
- Hospital Italiano Ctro. Agustín Rocca-San Justo (HICAR), Buenos Aires, Argentina
| | - Bryan Williams
- Institute of Cardiovascular Sciences and NIHR University College London Hospitals Biomedical Research Centre, University College London, London, UK
| | - Irene Ennis
- Centro de Investigaciones Cardiovasculares, Facultad de Ciencias Médicas, UNLP-CONICET, La Plata, Argentina
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12
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Zhang ZY, Yu YL, Asayama K, Hansen TW, Maestre GE, Staessen JA. Starting Antihypertensive Drug Treatment With Combination Therapy: Controversies in Hypertension - Con Side of the Argument. Hypertension 2021; 77:788-798. [PMID: 33566687 PMCID: PMC7884241 DOI: 10.1161/hypertensionaha.120.12858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Zhen-Yu Zhang
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z., Y.-L.Y., K.A.)
| | - Yu-Ling Yu
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z., Y.-L.Y., K.A.)
| | - Kei Asayama
- From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (Z.-Y.Z., Y.-L.Y., K.A.)
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A.)
- Tohoku Institute for Management of Blood Pressure, Sendai, Japan (K.A.)
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
| | - Tine W. Hansen
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
- Steno Diabetes Center Copenhagen, Capital Region of Denmark, Denmark (T.W.H.)
| | - Gladys E. Maestre
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
- Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX (G.E.M.)
- Alzheimer´s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX (G.E.M.)
| | - Jan A. Staessen
- Research Institute Alliance for the Promotion of Preventive Medicine (APPREMED), Mechelen, Belgium (K.A., G.E.M., T.W.H., J.A.S)
- Biomedical Sciences Group, Faculty of Medicine, University of Leuven, Belgium (J.A.S.)
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13
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Williams B, Masi S, Wolf J, Schmieder RE. Facing the Challenge of Lowering Blood Pressure and Cholesterol in the Same Patient: Report of a Symposium at the European Society of Hypertension. Cardiol Ther 2020; 9:19-34. [PMID: 31933276 PMCID: PMC7237547 DOI: 10.1007/s40119-019-00159-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Indexed: 11/24/2022] Open
Abstract
A symposium held at the 29th European Meeting on Hypertension and Cardiovascular Protection in Milan, Italy, discussed the potential impact and long-term benefits of early active management of cardiovascular disease (CVD) risk in patients with hypertension, and potential barriers to this strategy. Hypertension often aggregates with other cardiovascular risk factors, exponentially increasing morbidity and mortality. While effective therapies to treat hypertension exist, a substantial number of patients still experience major cardiovascular events. Two major issues account for these disappointing results: interventions initiated too late in the disease trajectory and lack of effective translation of the research findings into daily clinical practice. Results from genetic studies suggest that lifetime exposure to lower blood pressure (BP) and cholesterol levels due to protective gene mutations, can provide greater cardiovascular benefits than middle-/late-age interventions. Clinical guidelines suggest adding statins to BP-lowering therapies for further cardiovascular benefits in most hypertensive patients; however, real-world data show that physicians' compliance with these recommendations and patients' adherence to BP- and lipid-lowering treatments remain poor, resulting in poor risk factor control and an increased risk of adverse outcomes. The use of single-pill combinations (SPC) can partially mitigate these issues, as they are associated with increased patient adherence and improved BP control. Treatment with SPC has been recommended in the European Hypertension Guidelines, but optimization of the total CVD risk may need adoption of more ambitious treatment strategies aimed to deliver single pills that control multiple CVD risk factors. Amlodipine, perindopril and atorvastatin have been shown to improve BP and lipid levels to a great extent when given separately, and this combination has also been shown to improve cardiovascular outcomes. Overall, early intervention in patients with hypertension with use of an effective, high-intensity cardiovascular risk reduction regimen and attention to medication adherence through reducing pill burden are likely to result in optimal outcomes.
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Affiliation(s)
- Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK.
| | - Stefano Masi
- Institute of Cardiovascular Sciences, University College London, London, UK
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nuremberg, Erlangen, Germany
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14
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Does the Polypill Improve Patient Adherence Compared to Its Individual Formulations? A Systematic Review. Pharmaceutics 2020; 12:pharmaceutics12020190. [PMID: 32098393 PMCID: PMC7076630 DOI: 10.3390/pharmaceutics12020190] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
Many patients, especially those with a high pill burden and multiple chronic illnesses, are less adherent to medication. In medication treatments utilizing polypills, this problem might be diminished since multiple drugs are fused into one formulation and, therefore, the therapy regimen is simplified. This systematic review summarized evidence to assess the effect of polypills on medication adherence. The following databases were searched for articles published between 1 January 2000, and 14 May 2019: PubMed, Web of Science, Cochrane Library, and Scopus. Medication adherence was the only outcome assessed, regardless of the method of measuring it. Sixty-seven original peer-reviewed articles were selected. Adherence to polypill regimens was significantly higher in 56 articles (84%) compared to multiple pill regimens. This finding was also supported by the results of 13 out of 17 selected previously published systematic reviews and meta-analyses dealing with this topic. Adherence can be improved through the formulation of polypills, which is probably why the interest in researching them is growing. There are many polypills on the market, but the adherence studies so far focused mainly on a small range of medical conditions.
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15
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Elnaem MH, Irwan NA, Abubakar U, Syed Sulaiman SA, Elrggal ME, Cheema E. Impact of Medication Regimen Simplification on Medication Adherence and Clinical Outcomes in Patients with Long-Term Medical Conditions. Patient Prefer Adherence 2020; 14:2135-2145. [PMID: 33173282 PMCID: PMC7646472 DOI: 10.2147/ppa.s268499] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study aims to identify interventions used to reduce medication regimen complexity and to assess their impact on medication adherence and clinical outcomes. METHODS A literature search was conducted using pre-defined search terms in three scientific databases, including ScienceDirect, ProQuest and MEDLINE. Original research articles published in English between 2009 and 2020 that assessed the impact of medication regimen simplification on medication adherence in patients with long-term medical conditions were eligible for inclusion. Review articles, meta-analysis studies and conference proceedings were excluded. Data charting was done in an iterative process using a study-specific extraction form. RESULTS Of the 684 studies identified through initial searches, 17 studies were included in the review. Nine studies involved simplification of medication regimen related to HIV, while three studies focused on patients with diabetes with or without coronary artery disease. The remaining five studies included medications used among elderly patients or medications related to hypertension, psychiatric disorders, glaucoma and kidney diseases. Three medication regimen simplification strategies were identified; fixed-dose combination (n = 7), once-daily dosing (n = 4) and the combination of both fixed-dose and once-daily dosing (n = 6). Overall, most of the regimen simplification strategies (14 out of 17) were found to be useful in improving medication adherence. There was no assessment of clinical outcomes in four out of 17 studies. Furthermore, more than half of the studies that assessed clinical outcomes did not show any additional impact on clinical outcomes. CONCLUSION The findings suggest that there was an equal utilization of the three main approaches of regimen simplifications; fixed-dose combination, once-daily dosing and a combination of both. Overall, most of the regimen simplification strategies were found to be effective in improving medication adherence. However, the associated improvement in medication adherence did not extend to improvement in the clinical outcomes.
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Affiliation(s)
- Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
- Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Nor Afifah Irwan
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Usman Abubakar
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mahmoud E Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ejaz Cheema
- School of Pharmacy, University of Birmingham, Edgbaston, BirminghamB15 2TT, UK
- Correspondence: Ejaz Cheema School of Pharmacy, University of Birmingham, Edgbaston, BirminghamB15 2TT, UKTel +44-121-4146845 Email
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16
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Kelleher JF, Madi AM, Gilvary GC, Tian YW, Li S, Almajaan A, Loys ZS, Jones DS, Andrews GP, Healy AM. Metformin Hydrochloride and Sitagliptin Phosphate Fixed-Dose Combination Product Prepared Using Melt Granulation Continuous Processing Technology. AAPS PharmSciTech 2019; 21:23. [PMID: 31832799 DOI: 10.1208/s12249-019-1553-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022] Open
Abstract
The development of oral solid dosage forms, such as tablets that contain a high dose of drug(s), requires polymers and other additives to be incorporated at low levels as possible, to keep the final tablet weight low, and, correspondingly, the dosage form size small enough to be acceptable from a patient perspective. Additionally, a multi-step batch-based manufacturing process is usually required for production of solid dosage forms. This study presents the development and production, by twin-screw melt granulation technology, of a high-dose immediate-release fixed-dose combination (FDC) product of metformin hydrochloride (MET) and sitagliptin phosphate (SIT), with drug loads of 80% w/w and 6% w/w, respectively. For an 850/63 mg dose of MET/SIT, the final weight of the caplets was approximately 1063 mg compared with 1143 mg for the equivalent dose in Janumet®, the marketed product. Mixtures of the two drugs and polymers were melt-granulated at temperatures below the individual melting temperatures of MET and SIT (231.65 and 213.89°C, respectively) but above the glass transition temperature or melting temperature of the binder(s) used. By careful selection of binders, and processing conditions, direct compressed immediate-release caplets with desired product profiles were successfully produced. The melt granule formulations before compression showed good flow properties, were larger in particle size than individual starting API materials and were easily compressible. Melt granulation is a suitable platform for developing direct compressible high-dose immediate-release solid dosage forms of FDC products.
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17
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Lavra ZMM, de Medeiros FPM, da Silva RMF, Rosa TA, Wanderley Sales VDA, Barros Silva LCPB, de Sousa ALMD, de Lima LG, Rolim LA, Neto PJR. Formulation, Development and Scale-Up of Fixed-Dose Combination Tablets Containing Zidovudine, Lamivudine and Nevirapine. Curr HIV Res 2019; 17:360-367. [DOI: 10.2174/1570162x17666190927162155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/16/2022]
Abstract
Background:
The development of antiretroviral associations in a single dosage form aims
to ensure improved efficacy, low costs and better adherence to treatment.
Objective:
This work performed the pharmacotechnical development, coating, and stability studies
of fixed-dose combination tablets of zidovudine, lamivudine and nevirapine (300 + 200 + 150 mg,
respectively).
Methods:
Qualitative and quantitative planning of diluents (101 and 250 microcrystalline cellulose,
spray-dried monohydrate lactose and corn starch) and coating polymers (Opadry white II HP® and
Instacoat Aqua Moistshield II®) were analyzed, and direct compression (DC) and wet granulation
(WG) methods were tested aiming the development of the pharmaceutical form. Quality control was
carried out according to the specifications set by official compendia. The chosen formulation was
scaled-up and the industrial batches were submitted to accelerated and long-term stability studies.
Results:
The batches obtained by WG met the requirements, using 101 microcrystalline cellulose,
corn starch and Opadry white II HP®
as excipients. The DC trial was not possible due to the need of
a greater ratio of excipients to improve formulation properties.
Conclusion:
Thus, this study brings a new therapeutic alternative for HIV treatment, contributing to
the development of another possibility to simplify drug administration.
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Affiliation(s)
- Zênia Maria Maciel Lavra
- Secretariat of Science, Technology and Strategic Inputs - Ministry of Health, Brasilia, DF, Brazil
| | | | - Rosali Maria Ferreira da Silva
- Laboratorio de Tecnologia dos Medicamentos, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife-PE, Brazil
| | - Talita Atanazio Rosa
- Laboratorio de Tecnologia dos Medicamentos, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife-PE, Brazil
| | | | | | | | | | - Larissa Araújo Rolim
- Pharmacy Collegiate, Federal University of Vale do Sao Francisco, Petrolina-PE, Brazil
| | - Pedro José Rolim Neto
- Laboratorio de Tecnologia dos Medicamentos, Department of Pharmaceutical Sciences, Federal University of Pernambuco, Recife-PE, Brazil
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18
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Alfian SD, Pradipta IS, Hak E, Denig P. A systematic review finds inconsistency in the measures used to estimate adherence and persistence to multiple cardiometabolic medications. J Clin Epidemiol 2019; 108:44-53. [DOI: 10.1016/j.jclinepi.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/15/2018] [Accepted: 12/05/2018] [Indexed: 02/08/2023]
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Affiliation(s)
| | - Federico Rea
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology, and Public Health (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology, and Public Health (F.R., G.C.), University of Milano-Bicocca, Italy
| | - Guido Grassi
- Department of Medicine and Surgery Clinica Medica (G.G.), University of Milano-Bicocca, Italy
- IRCCS Mutimedica, Sesto San Giovanni, Milan, Italy (G.G.)
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20
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Volpe M, Gallo G, Tocci G. New approach to blood pressure control: Triple combination pill. Trends Cardiovasc Med 2019; 30:72-77. [PMID: 30926237 DOI: 10.1016/j.tcm.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 12/01/2022]
Abstract
Blood pressure (BP) control remains insufficient worldwide, mostly due to poor adherence to treatments, clinical inertia, adverse effects and underuse of drug-combination strategies. Monotherapy and its uptitration have been long considered the first-line strategy in the treatment of hypertension, often leading to ineffective, time consuming and frustrating results. On the other hand, several studies have demonstrated that starting and continuing antihypertensive therapy based on a drug combination is associated with a greater reduction of BP, an earlier achievement of therapeutic goals and a higher proportion of patients achieving targets with favorable implications on cardiovascular events. However, one-fourth to one-third of hypertensive patients fail to achieve BP control even with dual combination therapies, requiring three or more antihypertensive agents. The aim of this review is to discuss the effects of triple-drug associations in terms of BP lowering and prevention of major cardiovascular events, also in high-risk patients. We also discuss available data on side effects and tolerability of triple combination therapy, and the advantages to use a single-pill formulation to promote simplification and adherence to therapy. The findings reported have provided the background for most recent international guidelines on hypertension that support the use of dual and triple combination therapy for most patients.
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Affiliation(s)
- Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy.
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Giuliano Tocci
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
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Mahmood S, Hussain S, Ur Rehman T, Barbui C, Kurdi AB, Godman B. Trends in the prescribing of antipsychotic medicines in Pakistan: implications for the future. Curr Med Res Opin 2019; 35:51-61. [PMID: 30122062 DOI: 10.1080/03007995.2018.1513834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction and objectives: There is a paucity of antipsychotic prescribing and utilization data in Pakistan that needs addressing, especially with issues of availability, affordability, gender differences, and domestic violence, to develop pertinent strategies. The objective of this study was to address these issues by describing current antipsychotic utilization patterns in Pakistan among adult patients attending tertiary care hospitals and private practitioners.Methods: A three staged approach was used including (1) assessment of total antipsychotic utilization, expenditure, and costs per unit between 2010 and 2015, (2) an in-depth retrospective study of prescribing patterns, including co-morbidities among representative hospital patients in Pakistan, and (3) assessment of the quality of prescribing against WHO targets.Results: Total use of antipsychotics increased 4.3-fold and the cost/unit increased by 13.2% during the study period. Risperidone and olanzapine were the most prescribed antipsychotics with more limited use of other typical and atypical antipsychotics. The number of medicines per encounter was 4.56. Prescription using generic instead of brand names was 21.4%. Seven per cent were prescribed more than one antipsychotic concurrently.Conclusion: There has been an appreciable increase in antipsychotic utilization in recent years in Pakistan, especially atypical antipsychotics, with little polypharmacy. Ongoing utilization of typical antipsychotics may be due to comorbidities such as diabetes and cardiovascular disease. Issues of international non-proprietary name prescribing need investigating along with the high number of medicines per encounter and gender inequality.
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Affiliation(s)
- Sidra Mahmood
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | | | - Taufeeq Ur Rehman
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Amanj Baker Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, Guanteng Province, South Africa
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22
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Pietropaoli D, Del Pinto R, Ferri C, Wright JT, Giannoni M, Ortu E, Monaco A. Poor Oral Health and Blood Pressure Control Among US Hypertensive Adults. Hypertension 2018; 72:1365-1373. [DOI: 10.1161/hypertensionaha.118.11528] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Davide Pietropaoli
- From the Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L’Aquila, Italy (D.P., R.D.P., C.F., M.G., E.O., A.M.)
| | - Rita Del Pinto
- From the Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L’Aquila, Italy (D.P., R.D.P., C.F., M.G., E.O., A.M.)
| | - Claudio Ferri
- From the Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L’Aquila, Italy (D.P., R.D.P., C.F., M.G., E.O., A.M.)
| | - Jackson T. Wright
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH (J.T.W.)
| | - Mario Giannoni
- From the Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L’Aquila, Italy (D.P., R.D.P., C.F., M.G., E.O., A.M.)
| | - Eleonora Ortu
- From the Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L’Aquila, Italy (D.P., R.D.P., C.F., M.G., E.O., A.M.)
| | - Annalisa Monaco
- From the Department of Life, Health, and Environmental Sciences, San Salvatore Hospital, University of L’Aquila, Italy (D.P., R.D.P., C.F., M.G., E.O., A.M.)
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23
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Implementation of the Chronic Care Model to Reduce Disparities in Hypertension Control: Benefits Take Time. J Gen Intern Med 2018; 33:1498-1503. [PMID: 29948807 PMCID: PMC6108988 DOI: 10.1007/s11606-018-4526-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND The Chronic Care Model (CCM) has been endorsed by experts to reduce disparities in chronic disease outcomes but benefits may be slow to appear in low-income populations. OBJECTIVE To evaluate the effect of CCM implementation on systolic blood pressure (SBP) control in minority patients with diabetes mellitus (DM). DESIGN Retrospective study from 2012 to 2016 in two primary care clinics with primarily uninsured, Hispanic patients. PATIENTS Four 2-year cohorts of patients aged 18-75 with DM and SBP ≥ 140 mmHg on HTN drugs in year 1 and SBP measured 1 year later in year 2. INTERVENTION Implementation of CCM for DM in January 2014 involved: electronic medical record revision, a DM registry, hypertension (HTN) treatment protocol, team education, performance feedback, and case management. MAIN MEASURE SBP < 140 mmHg in year 2. KEY RESULTS Of 2354 patients, the mean age was 56.2 (SD 9.5), baseline SBP 153.8 (SD 14.9) mmHg, and 79.8% Hispanic. Last SBP < 140 mmHg was 58.4% for cohort 1 (2012-2013) and 68.5% for cohort 4 (2015-2016). Adjusted odds ratios (AORs) for SBP control versus cohort 1 were 1.35 (95% CI 1.07, 1.69) for cohort 3 (2014-2015) and 2.13 (95% CI 1.60, 2.80) for cohort 4. AORs for SBP control were reduced by 15% per HTN drug at baseline (P = 0.001), 9% per HTN drug added at last SBP (P = 0.024), and 22% for multi-dose HTN drugs (P = 0.004). Among patients with persistent elevated SBP and represented in multiple cohorts, AORs for control were still over 2-fold higher for cohort 4 versus cohort 1. CONCLUSIONS After adopting the CCM for primarily Hispanic patients with DM, SBP control increased significantly despite treatment with fewer HTN drugs. Yet improvement took 3-4 years, suggesting that financial rewards for using the CCM to achieve improved clinical outcomes for low-income, minority patients may be delayed.
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Kawalec P, Holko P, Gawin M, Pilc A. Effectiveness of fixed-dose combination therapy in hypertension: systematic review and meta-analysis. Arch Med Sci 2018; 14:1125-1136. [PMID: 30154897 PMCID: PMC6111352 DOI: 10.5114/aoms.2018.77561] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/09/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Clinical studies have revealed that fixed-dose combinations (FDCs) of drugs can have a better effect on blood pressure than free-equivalent combinations (FECs). Our objectives were to perform an up-to-date assessment of the effectiveness of FDCs and FECs in antihypertensive therapy, to provide more accurate results by using a stratified meta-analysis. MATERIAL AND METHODS A systematic review was performed in PubMed, Web of Science, and Cochrane databases according to PRISMA guidelines. The outcomes were adherence (compliance), persistence to medication, reduction of blood pressure and the safety profile. We used the Newcastle Ottawa scale or the Delphi list for the assessment of the quality of cohort studies or clinical trials, respectively. Heterogeneity was assessed using the Cochrane Q test and I2 statistic. RESULTS Of 301 abstracts screened, 26 primary studies and 2 other meta-analyses were identified, of which 12 studies were included in the meta-analyses and 3 studies were included in the narrative review. The FDC treatment is associated with a significant improvement in adherence and persistence in comparison with FEC treatment, e.g., the average medicine possession ratio increased with FDC by 13.1% (p < 0.001). For endpoints correlated with higher adherence (e.g., a reduction in blood pressure), a nonsignificant benefit was observed for FDCs. Moreover, it was demonstrated that higher adherence can lead to a lower risk of cardiovascular events. CONCLUSIONS In comparison with FECs, the FDC treatment is associated with a significant improvement in the cooperation between a doctor and a patient and with increased patients' adherence to the treatment schedule.
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Affiliation(s)
- Paweł Kawalec
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Przemysław Holko
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Małgorzata Gawin
- Department of Food Biotechnology, Faculty of Food Technology, University of Agriculture, Krakow, Poland
| | - Andrzej Pilc
- Institute of Pharmacology Polish Academy of Sciences, Krakow, Poland
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Durand H, Hayes P, Harhen B, Conneely A, Finn DP, Casey M, Murphy AW, Molloy GJ. Medication adherence for resistant hypertension: Assessing theoretical predictors of adherence using direct and indirect adherence measures. Br J Health Psychol 2018; 23:949-966. [PMID: 30014548 DOI: 10.1111/bjhp.12332] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/01/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study examined theoretical predictors of long-term medication adherence (i.e., treatment-related beliefs, coherence of beliefs from experience with medication, habit strength, and pill burden) for patients with apparent treatment-resistant hypertension in primary care, using a composite adherence score derived from direct and indirect measures (i.e., prescription refill, self-report, and bioanalytical assays of urine). DESIGN Cross-sectional study. METHODS Individual patient records were screened for prescription refill adherence. Patients provided a urine sample for adherence screening and completed a battery of psychometric scales, including two self-report adherence measures (N = 204). Convergence of adherence measures was assessed, a composite adherence score was calculated, and hierarchical multiple regression was used to examine the role of theoretical predictors of adherence. RESULTS Non-adherence estimates ranged from 20.3 to 41.1%, depending on the assessment method used. Associations among adherence measures were weak to moderate (ρ = .00-.53). Medication-taking habit strength was the strongest predictor of adherence, explaining 19% incremental variance in adherence beyond treatment-related beliefs. Beliefs and coherence did not predict adherence, even for patients with weaker habits. Pill burden was not associated with habit strength or adherence for this sample. CONCLUSIONS Associations among unique adherence measures were weak overall, providing further evidence that multiple measures are necessary to accurately assess adherence. Habit strength is a key predictor of adherence for chronic conditions. Both habit strength and pill burden represent important intervention targets for improving long-term medication adherence. Longitudinal inception studies are needed to properly test Common-Sense Model propositions and elucidate the role of beliefs, coherence, and habits in predicting adherence at various stages of the chronic illness trajectory. Statement of contribution What is already known on this subject? Non-adherence to antihypertensives is a leading cause of apparent treatment-resistant hypertension (aTRH). Behaviour maintenance (vs. initiation) factors may be more predictive of long-term adherence. What does this study add? Associations among direct and indirect measures of adherence are generally weak. Habit strength is the strongest predictor of long-term adherence for aTRH in primary care. Inception studies are needed to further validate Common-Sense Model propositions.
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Affiliation(s)
- Hannah Durand
- Medication Adherence Across the Lifespan (MEDAL) Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Peter Hayes
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Brendan Harhen
- National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland
| | - Ann Conneely
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland, Galway, Ireland
| | - David P Finn
- Discipline of Pharmacology and Therapeutics, School of Medicine, National University of Ireland, Galway, Ireland
| | - Monica Casey
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Primary Care Clinical Trials Network, Galway, Ireland
| | - Gerard J Molloy
- Medication Adherence Across the Lifespan (MEDAL) Group, School of Psychology, National University of Ireland, Galway, Ireland
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Schaffer AL, Buckley NA, Pearson SA. Who benefits from fixed-dose combinations? Two-year statin adherence trajectories in initiators of combined amlodipine/atorvastatin therapy. Pharmacoepidemiol Drug Saf 2017; 26:1465-1473. [DOI: 10.1002/pds.4342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/17/2017] [Accepted: 10/01/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea L. Schaffer
- Centre for Big Data Research in Health; University of New South Wales; Sydney Australia
| | | | - Sallie-Anne Pearson
- Centre for Big Data Research in Health; University of New South Wales; Sydney Australia
- Menzies Centre for Health Policy; University of Sydney; Camperdown Australia
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Vrijens B, Antoniou S, Burnier M, de la Sierra A, Volpe M. Current Situation of Medication Adherence in Hypertension. Front Pharmacol 2017; 8:100. [PMID: 28298894 PMCID: PMC5331678 DOI: 10.3389/fphar.2017.00100] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/16/2017] [Indexed: 12/02/2022] Open
Abstract
Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension.
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Affiliation(s)
- Bernard Vrijens
- WestRock HealthcareVisé, Belgium; Department of Public Health, University of LiègeLiège, Belgium
| | | | - Michel Burnier
- Department of Nephrology and Hypertension, University Hospital Lausanne Lausanne, Switzerland
| | - Alejandro de la Sierra
- Internal Medicine Department, Hospital Mutua Terrassa, University of Barcelona Barcelona, Spain
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "La Sapienza"Rome, Italy; IRCCS NeuromedPozzilli, Italy
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Hypertension awareness, treatment, and control among diabetic and nondiabetic individuals in a multiethnic population in the Netherlands: the HELIUS study. J Hypertens 2016; 34:539-47; discussion 547. [PMID: 26820479 DOI: 10.1097/hjh.0000000000000820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There is a paucity of data on hypertension awareness, treatment and control among diabetic adults from different ethnic backgrounds. We assessed ethnic differences in prevalence, awareness, treatment, and control of hypertension among diabetic adults and how they are compared with individuals without diabetes. METHODS Baseline data from the Healthy Life in an Urban Setting study were used including 12 ,633 adults aged 18-70 years from six ethnic backgrounds in Amsterdam, the Netherlands. Age-sex-adjusted prevalence ratios were used to explore ethnic differences. RESULTS Among diabetic individuals, African-Surinamese (80.2%; 1.26, 95% confidence interval 1.06-1.51) and Ghanaians (81.7%; 1.40, 1.17-1.68) were more likely than Dutch (69.6%) to have hypertension. There were no significant ethnic differences in the rates of awareness and treatment, but blood pressure (BP) control rates among treated hypertensives were significantly lower in Ghanaians (41.7%; 0.66, 0.45-0.96) and African-Surinamese (28.7%; 0.53, 0.34-0.84) than Dutch (54.1%). Among nondiabetic adults, except Moroccans, all the ethnic minorities had higher prevalence rates of hypertension, awareness (except South-Asian Surinamese and Turks) and treatment than Dutch people. By contrast, BP control rates among treated hypertensives were lower in all ethnic minorities, with the differences being significant for African-Surinamese (42.5%; 0.68, 0.57-0.80), South-Asian Surinamese (41.8%; 0.68, 0.57-0.82), and Ghanaians (35.2%; 0.54, 0.45-0.65). CONCLUSION Hypertension awareness and treatment rates are similar among ethnic groups in both diabetics and nondiabetics. Adequate BP control remains low among ethnic minorities, particularly among diabetic African origin people. Major effort is needed to improve BP control among diabetic people given the cardiovascular complications associated with uncontrolled BP in this group.
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Marazzi G, Pelliccia F, Campolongo G, Cacciotti L, Massaro R, Poggi S, Tanzilli A, Di Iorio M, Volterrani M, Lainscak M, Rosano GM. Greater cardiovascular risk reduction with once-daily fixed combination of three antihypertensive agents and statin versus free-drug combination: The ALL-IN-ONE trial. Int J Cardiol 2016; 222:885-887. [PMID: 27522394 DOI: 10.1016/j.ijcard.2016.07.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The ultimate goal of antihypertensive therapy is cardiovascular risk (CVR) reduction. The aim of this study was to compare the efficacy and safety of once-daily fixed combination (ODFC) versus free-drug combination (FDC) of 3antihypertensive agents and statin. METHODS The ALL-IN-ONE trial was a 12-week randomized, prospective, multicenter trial. A total of 305 hypertensive patients were randomized 1:1. The "fixed group" was given an ODFC of perindropil 10mg plus indapamide 2.5mg plus amlodipine 5 or 10mg plus atorvastatin 20mg. The "free group" was given a FDC of the 3antihypertensive agents plus atorvastatin 20mg. Primary end-points were the differences in clinic BP, cholesterol levels and CVR risk between the 2 groups after treatments. Secondary end-points included intragroup differences in clinic BP. Safety and compliance were also assessed. RESULTS At 12-weeks, the fixed group had lower systolic BP and similar diastolic BP compared to the free group. BP targets at week 12 were more commonly reached with fixed than free combination (89% and 80% respectively, p=0.048). For cholesterol serum in both groups there was a significant reduction of values. Also CVR reduction was greater in those taking ODF. Safety was not significantly different between the 2 groups. Conversely, compliance was significantly greater in the fixed-group vs. the free-group. CONCLUSION This randomized trial shows that ODF combination of perindropil, indapamide and amlodipine is as safe as free combination of the 3 drugs, but is associated with a greater efficacy in BP control, compliance and, associated with statin, in cholesterol reduction. A better cardiovascular risk control is achieved with ODF combination than with a free administration. ClinicalTrials.gov ID: NCT02710539.
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Affiliation(s)
| | | | | | | | | | - Sara Poggi
- Sapienza University of Rome, 1st Faculty of Medicine, Rome, Italy
| | | | - Martina Di Iorio
- Sapienza University of Rome, 1st Faculty of Medicine, Rome, Italy
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Simonyi G, Ferenci T, Alföldi S, Farsang C. Ramipril + amlodipine and ramipril + hydrochlorothiazide fixed-dose combinations in relation to patient adherence. J Int Med Res 2016; 44:1087-1091. [PMID: 27435392 PMCID: PMC5536552 DOI: 10.1177/0300060516645004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Objective To compare 1-year treatment adherence of ramipril + amlodipine and ramipril +hydroclorothiazide fixed-dose combination therapies in patients with hypertension. Methods Data were extracted from the database of the National Health Insurance Fund of Hungary. Treatment adherence was modelled using survival analysis. Results At 2 months after initiation of treatment, 42% of patients using ramipril +hydrochlorothiazide (n = 28,800) had discontinued treatment, compared with 0% of patients using ramipril + amlodipine (n = 10,295). At 1 year, treatment adherence was 29% in the ramipril + hydrochlorothiazide group and 54% in the ramipril + amlodipine group. The hazard ratio for discontinuing ramipril + hydrochlorothiazide vs ramipril + amlodipine was 2.318 (95% confidence intervals 2.246, 2.392). Conclusion Ramipril + amlodipine had significantly higher 1-year treatment adherence than ramipril + hydrochlorothiazide in patients with hypertension.
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Affiliation(s)
- Gábor Simonyi
- 1 Metabolic Centre, Szent Imre University Teaching Hospital, Budapest, Hungary
| | - Tamás Ferenci
- 2 Physiological Control Group, John von Neumann Faculty of Informatics, Óbuda University, Budapest, Hungary
| | - Sándor Alföldi
- 1 Metabolic Centre, Szent Imre University Teaching Hospital, Budapest, Hungary
| | - Csaba Farsang
- 1 Metabolic Centre, Szent Imre University Teaching Hospital, Budapest, Hungary
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Tsunashima D, Yamashita K, Ogawara KI, Sako K, Higaki K. Preparation of extended release solid dispersion formulations of tacrolimus using ethylcellulose and hydroxypropylmethylcellulose by solvent evaporation method. J Pharm Pharmacol 2016; 68:316-23. [DOI: 10.1111/jphp.12515] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/13/2015] [Indexed: 11/27/2022]
Abstract
Abstract
Objectives
Tacrolimus is a poorly water-soluble compound that is used to prevent allograft rejection. We aimed to prepare an extended release formulation of tacrolimus to achieve both an extended release profile and improved solubility of tacrolimus.
Methods
Extended release granules (ERG) of tacrolimus were prepared with lactose, ethylcellulose (EC) and hydroxypropylmethylcellulose (HPMC) via the solvent evaporation method.
Key findings
In an in vitro release study, ERG had an extended release profile, and the release rate of tacrolimus was regulated by the quantity of lactose, EC and HPMC in the formulation. HPMC-containing ERG successfully enhanced and maintained supersaturation of tacrolimus even after 24 h in a supersaturated release study. In contrast, the extent of supersaturation rapidly decreased after 4 h and the concentration nearly reached the same level as that of crystalline tacrolimus at 24 h for ERG without HPMC. In vivo absorption characteristics were compared between ERGs and immediate release (IR) formulation of tacrolimus. Successful and sustained absorption of tacrolimus without reducing bioavailability compared with IR formulation was observed for ERG.
Conclusions
These results suggest the feasibility of combining an EC-based formulation with solid dispersion utilizing HPMC for the extended release of oral formulations and sustained absorption of tacrolimus.
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Affiliation(s)
- Daisuke Tsunashima
- Pharmaceutical Research and Technology Labs., Astellas Pharma Inc., Yaizu, Shizuoka, Japan
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Okayama University, Kita-ku, Japan
| | - Kazunari Yamashita
- Pharmaceutical Research and Technology Labs., Astellas Pharma Inc., Yaizu, Shizuoka, Japan
| | - Ken-ichi Ogawara
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Okayama University, Kita-ku, Japan
| | | | - Kazutaka Higaki
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Okayama University, Kita-ku, Japan
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Harmon L, Chilton RJ, Spellman C. Reducing Cardiovascular Events and End-Organ Damage in Patients with Hypertension: New Considerations. Postgrad Med 2015; 123:7-17. [DOI: 10.3810/pgm.2011.03.2258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Varagic J, Punzi H, Ferrario CM. Clinical utility of fixed-dose combinations in hypertension: evidence for the potential of nebivolol/valsartan. Integr Blood Press Control 2014; 7:61-70. [PMID: 25473311 PMCID: PMC4251532 DOI: 10.2147/ibpc.s50954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Despite significant advances in pharmacologic approaches to treat hypertension during the last decades, hypertension- and hypertension-related organ damage are still a high health and economic burden because a large proportion of patients with hypertension do not achieve optimal blood pressure control. There is now general agreement that combination therapy with two or more antihypertensive drugs is required for targeted blood pressure accomplishment and reduction of global cardiovascular risk. The goals of combination therapies are to reduce long-term cardiovascular events by targeting different mechanism underlying hypertension and target organ disease, to block the counterregulatory pathways activated by monotherapies, to improve tolerability and decrease the adverse effects of up-titrated single agents, and to increase persistence and adherence with antihypertensive therapy. Multiple clinical trials provide evidence that fixed-dose combinations in a single pill offer several advantages when compared with loose-dose combinations. This review discusses the advances in hypertension control and associated cardiovascular disease as they relate to the prospect of combination therapy targeting a third-generation beta (β) 1-adrenergic receptor (nebivolol) and an angiotensin II receptor blocker (valsartan) in fixed-dose single-pill formulations.
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Affiliation(s)
- Jasmina Varagic
- Hypertension and Vascular Research Center, Wake Forest University, Winston-Salem, NC USA ; Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA
| | - Henry Punzi
- Trinity Hypertension and Diagnostic Research Center, Carrollton, TX, USA ; Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos M Ferrario
- Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA ; Department of Internal Medicine and Nephrology, Wake Forest University, Winston-Salem, NC, USA
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Kreutz R, Ammentorp B, Laeis P, Sierra A. Efficacy and Tolerability of Triple‐Combination Therapy With Olmesartan, Amlodipine, and Hydrochlorothiazide: A Subgroup Analysis of Patients Stratified by Hypertension Severity, Age, Sex, and Obesity. J Clin Hypertens (Greenwich) 2014; 16:729-40. [PMID: 25243781 PMCID: PMC8031602 DOI: 10.1111/jch.12408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/30/2014] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
Abstract
This prespecified subgroup analysis of a phase III study examined the effect of adding hydrochlorothiazide (HCTZ) to olmesartan (OLM)/amlodipine (AML) in patients with moderate to severe hypertension stratified by age, sex, body mass index, and hypertension severity. A total of 2690 patients, aged 18 years and older, with seated blood pressure (SeBP) ≥160/100 mm Hg received placebo or OLM/AML 20/5 mg, 40/5 mg, or 40/10 mg during a 2‐week, double‐blind, run‐in period, after which they were allocated to one of eight treatment groups with the same OLM/AML dose or with HCTZ 12.5 mg or 25 mg added for 8 weeks. By week 10, greater reductions in SeBP were observed in each OLM/AML/HCTZ group (P<.05, respectively) compared with the corresponding dual dose. Adding HCTZ increased blood pressure–lowering efficacy in all subgroups, with a higher proportion of blood pressure goal achievement vs dual therapy. OLM/AML/HCTZ reduced SeBP to a greater extent than OLM/AML in patients with moderate to severe hypertensive; this was unaffected by baseline hypertension severity, age, sex, and obesity.
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Affiliation(s)
- Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology Charité, Universtitätsmedizin – Berlin Germany
| | | | | | - Alejandro Sierra
- Department of Internal Medicine Hospital Mutua Terrassa University of Barcelona Terrassa Spain
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Rakugi H, Nakata E, Sasaki E, Kagawa T. Evaluation of the efficacy and tolerability of fixed-dose combination therapy of azilsartan and amlodipine besylate in Japanese patients with grade I to II essential hypertension. Clin Ther 2014; 36:711-21. [PMID: 24742498 DOI: 10.1016/j.clinthera.2014.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/12/2014] [Accepted: 03/14/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines for the management of hypertension recommend using drugs with different mechanisms of action in antihypertensive regimens that include simple single-pill fixed-dose combination (FDC) products. OBJECTIVE The objective of this study was to compare the efficacy and tolerability of the FDC of azilsartan (AZI) and amlodipine besylate (AML) with those of AZI monotherapy and AML monotherapy in Japanese patients with grade 1 to 2 essential hypertension. METHODS This was a multicenter, randomized, double-blind, parallel-group study. After receiving placebo during a 4-week run-in period in a single-blind manner, patients were randomized to receive 1 of the following 5 treatments for 8 weeks: FDC containing AZI 20 mg and AML 5 mg (AZI/AML 20/5 mg), FDC containing AZI 20 mg and AML 2.5 mg (AZI/AML 20/2.5 mg), AZI 20 mg, AML 5 mg, or AML 2.5 mg once daily in a fasting or fed state. The primary end point was the change from baseline (week 0) in the seated trough diastolic blood pressure at week 8 (last observation carried forward [LOCF]), and the secondary end point was the change from baseline in the seated trough systolic blood pressure at week 8 (LOCF). Tolerability was assessed based on adverse events, vital signs, and physical examination findings. RESULTS Of the 800 patients who provided informed consent, 603 were randomized to receive AZI/AML 20/5 mg (150 patients), AZI/AML 20/2.5 mg (151 patients), AZI 20 mg (151 patients), AML 5 mg (75 patients), or AML 2.5 mg (76 patients). The mean baseline systolic/diastolic blood pressure was 160.7/100.3 mm Hg. The mean change from baseline in seated blood pressure at week 8 (LOCF) was -35.3/-22.3 mm Hg in the AZI/AML 20/5 mg group and -31.4/-19.2 mm Hg in the AZI/AML 20/2.5 mg group, indicating a reduction significantly greater than that in corresponding monotherapy groups (-21.5/-13.9 mm Hg in the AZI 20 mg group, -26.4/-15.5 mm Hg in the AML 5 mg group, and -19.3/-11.6 mm Hg in the AML 2.5 mg group; p < 0.0001 for all contrast tests). No remarkable difference was found in the incidences of adverse events, vital signs, and physical examination findings among the treatment groups. CONCLUSION This study found that the FDC of AZI/AML 20/5 mg and 20/2.5 mg exhibited greater antihypertensive effects compared with each monotherapy. The FDC of AZI/AML had a similar safety profile to that of each monotherapy and was tolerable to Japanese patients with grade 1 to 2 essential hypertension. JAPAN PHARMACEUTICAL INFORMATION CENTER REGISTRATION Japic CTI-111606.
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Affiliation(s)
- Hiromi Rakugi
- Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Emi Nakata
- Pharmaceutical Development Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - Emma Sasaki
- Pharmaceutical Development Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - Tomoya Kagawa
- Pharmaceutical Development Division, Takeda Pharmaceutical Company Limited, Osaka, Japan
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Flynn C, Bakris GL. Role of ambulatory blood pressure monitoring in hypertension and diabetes. Curr Hypertens Rep 2013; 15:137-42. [PMID: 23595358 DOI: 10.1007/s11906-013-0352-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The prevalence of hypertension and diabetes are both rising in the USA and around the globe. The treatment of hypertension in the ambulatory setting begins with proper blood pressure measurement, and often the involvement of home blood pressure monitoring. If the diagnosis of hypertension is confirmed, then education on lifestyle modifications is the foundation to reaching blood pressure goals. If it is unclear, then ambulatory blood pressure monitoring should be performed to properly evaluate daily trends in blood pressure. The National Institute for Health and Clinical excellence (NICE) recommends 24-hour ambulatory blood pressure evaluation in all newly diagnosed patients with hypertension. The much-anticipated JNC 2013, while not likely to endorse this approach, will likely recommend an office goal systolic blood pressure of less than 140 mmHg in patients with diabetes as do the most recent American Diabetes Association clinical practice guidelines. All new guidelines are derived from a critical evidence based evaluation of the available data.
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Affiliation(s)
- Colleen Flynn
- Department of Medicine, ASH Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, 5841 S. Maryland Ave. MC 1027, Chicago, IL 60637, USA
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Compliance and persistence of free-combination antihypertensive therapy versus single-pill combination in Korean hypertensive patients. Int J Cardiol 2013; 168:4576-7. [PMID: 23871625 DOI: 10.1016/j.ijcard.2013.06.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/21/2013] [Accepted: 06/30/2013] [Indexed: 11/22/2022]
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Björnsdóttir US, Gizurarson S, Sabale U. Potential negative consequences of non-consented switch of inhaled medications and devices in asthma patients. Int J Clin Pract 2013; 67:904-10. [PMID: 23773278 PMCID: PMC3902990 DOI: 10.1111/ijcp.12202] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 04/30/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Asthma requires individually tailored and careful management to control and prevent symptoms and exacerbations. Selection of the most appropriate treatment is dependent on both the choice of drugs and inhaler device; however, financial pressures may result in patients being switched to alternative medications and devices in an attempt to reduce costs. AIM This review aimed to examine the published literature in order to ascertain whether switching a patient's asthma medications or device negatively impacts clinical and economic outcomes. MATERIALS AND METHODS A literature search of MEDLINE (2001-13 September 2011) was conducted to identify English-language articles focused on the direct impact of switching medications and inhaler devices and switching from fixed-dose combination to monocomponent therapy via separate inhalers in patients with asthma; the indirect impacts of switching were also assessed. RESULTS Evidence showed that non-consented switching of medications and inhalers in patients with asthma can be associated with a range of negative outcomes, at both individual and organisational levels. Factors that reduce adherence may lead to compromised symptom control resulting in increased healthcare resource utilisation and poorer patient quality of life. DISCUSSION The consequences of a non-consented switch should be weighed carefully against arguments supporting an inhaler switch without the patient's consent for non-medical/budgetary reasons, such as potential reductions in initial acquisition costs, which may be associated with subsequent additional healthcare needs. CONCLUSION Given the increasing pressure for reduced costs and efficient allocation of limited healthcare resources, an additional investment in ensuring high medication adherence may lead to greater savings due to a potentially decreased demand for healthcare services. In contrast, savings achieved in acquisition costs may result in a greater net loss due to increased healthcare consumption caused by decreased asthma control.
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Affiliation(s)
- U S Björnsdóttir
- Department of Allergy and Immunology, University of Iceland, Reykjavik, Iceland.
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Salas M, Kiefe CI, Schreiner PJ, Kim Y, Juarez L, Person SD, Williams OD. Obesity Modifies the Association of Race/Ethnicity with Medication Adherence in the CARDIA Study. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 1:41-54. [PMID: 22272756 DOI: 10.2165/01312067-200801010-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess associations between race/ethnicity and medication adherence, and the potential modifying effects of weight category (normal, overweight, obese) in a community-based sample. STUDY DESIGN AND SETTING We studied 1355 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study who were taking prescription medications in 2000-1. Medication adherence, as rated on the four-item Morisky medication adherence scale (score of 4 = maximum adherence), was reported for all participants. RESULTS The mean age ± SD of participants was 40 ± 3.6 years; 45% were African American and 36% were male. Overall, Whites had a higher proportion of maximum adherence than African Americans (59 vs 41%, respectively; p = 0.001). However, this difference was statistically significant only for participants within the normal weight category, of whom 54% of Whites were maximally adherent versus 35% of African Americans (p < 0.05). After adjustment for possible confounding covariates, race/ethnicity was associated with adherence only in those of normal weight: the odds ratio for maximum adherence in Whites versus African Americans of normal weight was 1.98 (95% CI 1.13, 3.47). Within race/ethnicity subgroups, weight category was associated with adherence in Whites but not in African Americans. CONCLUSION Weight category modifies the association of race/ethnicity with medication adherence. The high levels of non-adherence observed among African Americans and obese and overweight Whites bodes poorly for treatment of obesity-associated diseases such as cardiovascular disease or diabetes mellitus.
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Affiliation(s)
- Maribel Salas
- 1 Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA 2 Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Hong SH, Wang J, Tang J. Dynamic view on affordability of fixed-dose combination antihypertensive drug therapy. Am J Hypertens 2013; 26:879-87. [PMID: 23512697 DOI: 10.1093/ajh/hpt035] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of fixed-dose combinations (FDCs) has been increasing since the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommended using ≥2 drugs as the first-line drug therapy for patients with stage 2 hypertension. FDCs simplify the drug therapy regimen and reportedly lower the drug therapy cost compared with the free combination (FC) of 2 single-agent drugs. This study hypothesized that the affordability of FDCs over FCs would change over time depending on the availability of generic single-agent drugs. METHODS This study used the 2009 Medical Expenditure Panel Survey. Antihypertensive drugs were identified based on the Food and Drug Administration national drug directory. Based on the 2 databases, regression models were run to predict average monthly drug cost as well as out-of-pocket cost for each prescription along with their 95% confidence intervals (CIs). RESULTS Overall, FDCs (n = 26) had average monthly drug costs similar to respective FCs when FCs were not generically available. However, when FCs were generically available, FDCs (n = 11) had average drugs costs much higher than their respective FCs. For example, Lotrel as an FDC had an average monthly drug cost of $115.97 (95% CI = $96.59-$135.36), whereas its counterpart FC had an average monthly drug cost of $21.00 (95% CI = $18.23-$23.79). CONCLUSIONS The cost advantage of FDCs over FCs was reversed when FCs were generically available. The finding of this study informs patients, health-care providers, and drug plans of the importance of making dynamic decisions on preferred drug therapy options depending on the availability of generic drugs.
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Affiliation(s)
- Song Hee Hong
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
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Ferrario CM, Panjabi S, Buzinec P, Swindle JP. Clinical and economic outcomes associated with amlodipine/renin–angiotensin system blocker combinations. Ther Adv Cardiovasc Dis 2013; 7:27-39. [DOI: 10.1177/1753944712470979] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Since treatment regimen type can influence adherence and other outcomes, this study examined adherence, cardiovascular events, and economic outcomes in patients with hypertension treated with fixed-dose combination (FDC) amlodipine/olmesartan (AML/OM), FDC AML/benazepril (AML/BEN), and loose-dose combination AML plus angiotensin II receptor blockers (LDC AML/ARBs). Methods: Commercial health plan enrolees aged at least 18 years with index claim(s) for AML/OM, AML/BEN, or LDC AML/ARB were identified. Absence of study drug 6 months pre index, and continuous enrolment for at least 12 months post index were required. Descriptive analyses were executed to make comparisons between treatments, as well as multivariate models adjusting for baseline demographic and clinical characteristics, including propensity for assignment to study drug. Results: Descriptive results suggested mean follow-up adherence was higher in the AML/OM cohort [proportion of days covered (PDC) = 0.63] compared with the AML/BEN (PDC = 0.55; p < 0.001) and LDC AML/ARB cohorts (PDC = 0.34; p < 0.001). The proportion of individuals with an incident follow-up cardiovascular event composite was lower in the AML/OM cohort versus the AML/BEN and LDC AML/ARB cohorts (5.94% versus 7.85% and 16.89% respectively). Adjusted Cox models suggested that patients initiated on LDC AML/ARB (hazard ratio 1.35; p < 0.001), but not on AML/BEN, were at greater risk of a follow-up cardiovascular event (composite) compared with AML/OM. Adjusted generalized linear models suggested that mean follow-up per-member-per-month overall costs were higher in the AML/BEN (cost ratio = 1.169; p < 0.001; unadjusted mean cost US$780) and LDC AML/ARB cohorts (cost ratio = 1.286; p < 0.001; unadjusted mean cost US$1394) compared with the AML/OM cohort (unadjusted mean cost US$740). Conclusion: The results suggested that treatment with FDC AML/OM was associated with greater likelihood of adherence and lower overall costs than with FDC AML/BEN and LDC AML/ARB, and lower risk of cardiovascular event composite versus LDC AML/ARB.
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Affiliation(s)
- Carlos M. Ferrario
- Departments of Surgery, Internal Medicine–Nephrology, and Physiology–Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Jason P. Swindle
- OptumInsight, 200 West Madison Street, Suite 2000, Chicago, IL 60606, USA
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Bakris GL, Sowers JR. Treatment of hypertension in patients with diabetes-an update. ACTA ACUST UNITED AC 2012; 3:150-5. [PMID: 20409955 DOI: 10.1016/j.jash.2009.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- George L Bakris
- Hypertensive Diseases and Diabetes Center, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Abstract
Uncontrolled hypertension imposes a substantial global health burden, and poor patient compliance with prescribed antihypertensive medication makes a major contribution to the development of suboptimal blood pressure (BP) control. The asymptomatic nature of hypertension, side effects of medication, treatment complexity, and high pill burdens all have a negative impact on patient compliance. It is important to address the issue of poor patient compliance as studies have shown that good compliance is associated with improvement of BP control and positive health outcomes. As the majority of hypertensive patients require treatment with two or more agents to achieve goal BP, treatment guidelines have acknowledged the value of simplifying treatment through the use of fixed-dose combination (FDC) therapy. Triple FDC therapy comprising an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker), calcium channel blocker, and thiazide diuretic is a novel treatment strategy for the improvement of BP control in hard-to-treat patients.
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Affiliation(s)
- Serap Erdine
- Department of Cardiology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
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Erdine S. How do Compliance, Convenience, and Tolerability Affect Blood Pressure Goal Rates? Am J Cardiovasc Drugs 2012. [DOI: 10.2165/11635450-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
Systemic hypertension is a long-term risk factor for the development of atherosclerotic vascular disease and when uncontrolled is a short-term trigger of acute vascular events such as acute coronary syndromes and stroke. Thus, rapid reduction in BP is desirable. Patients at high risk for vascular disease, such as those with diabetes mellitus, have aggressive goal BP targets because studies have shown that achieving these targets reduces events. Given the dual goals in high-risk patients of reducing BP quickly and to aggressively low targets, the classic 'step therapy' of one drug titrated at a time to reduce BP is inadequate. Combination therapy with at least two potent medications makes more sense, and manufacturers are now increasing their offerings of single-pill combinations for hypertension. Combination pills are popular with patients and increase compliance with therapy. Many believe that renin-angiotensin aldosterone system (RAAS) blockers are the cornerstone of hypertension treatment in patients at high risk for vascular disease. The newer combination pills include a RAAS blocker and diuretics or a long-acting calcium channel antagonist (CCA). Recent studies have shown that a RAAS blocker plus a dihydropyridine CCA is superior to older diuretic-based combinations for preventing cardiovascular events. These considerations support a new approach to the higher risk hypertensive patient: effective doses of RAAS blocker/CCA combination pills to rapidly lower BP to <130/80 mmHg.
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Affiliation(s)
- Michael H Crawford
- Division of Cardiology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143-0124, USA.
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Ulusoy S, Ozkan G, Konca C, Kaynar K. A comparison of the effects of fixed dose vs. single-agent combinations on 24-h blood pressure variability. Hypertens Res 2012; 35:1111-7. [DOI: 10.1038/hr.2012.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Wu Y, Hu Y, Tang X, He L, Ren T, Tao Q, Qin X, Sun N, Wang H, Cao W, Wu T, Zhan S, Wang J, Chen W, Li L. Long-term efficacy and tolerability of a fixed-dose combination of antihypertensive agents: an open-label surveillance study in China. Clin Drug Investig 2012; 31:769-77. [PMID: 21671689 DOI: 10.1007/bf03256917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A fixed-dose combination (FDC) of four compounds, hydrochlorothiazide 12.5 mg, triamterene 12.5 mg, dihydralazine 12.5 mg and reserpine 0.1 mg (HTDR), is widely used as an antihypertensive treatment in China. Although HTDR has been used in China for more than 30 years, there have been few comprehensive evaluations of this treatment. OBJECTIVE The aim of this study was to investigate the long-term efficacy and tolerability of HTDR in Chinese patients with essential hypertension. METHODS This was a 36-month, community-based, open-label surveillance study, conducted in the Huangpu District (Shanghai, China). The study was based in local primary healthcare settings. Subjects were recruited if they had essential hypertension, were aged ≥35 years at the time of enrolment, were expected to remain in the area for 3 years, and were able to provide informed consent. Patients who had secondary hypertension, myocardial infarction or stroke within 6 months of screening, impaired renal or hepatic function, history of cardiomyopathy or chronic heart failure, or were pregnant or lactating were excluded. HTDR was administered as one or two tablets per day in the morning. If necessary, additional hydrochlorothiazide was added. Blood pressure (BP) was measured at baseline and throughout the 36-month surveillance period every 3 months. Biochemical indicators (e.g. fasting blood glucose, plasma lipid parameters, plasma sodium and potassium, plasma uric acid and serum creatinine) were also measured, and adverse events were noted. BP reductions and the rate at which patients achieved BP targets (systolic BP [SBP] <140 mmHg and diastolic BP [DBP] <90 mmHg) throughout the period were determined. Subgroup analyses by sex and age were also conducted. RESULTS A total of 1529 patients (550 male, 979 female; mean age 65.7 years) entered the study. After the 36-month treatment period, 93.1% of patients had achieved the SBP target, 97.9% had achieved the DBP target, and 92.1% had achieved both. The mean decreases in SBP and DBP were 15.3 mmHg and 9.9 mmHg, respectively. Overall, 127 adverse events in 119 patients (7.8%) occurred during the follow-up period, most of which were mild to moderate. Plasma lipid profiles were improved after 24 months of treatment. In addition, a significant increase in plasma potassium and a significant reduction in plasma uric acid were seen. CONCLUSION HTDR was found to have good long-term efficacy and tolerability in Chinese patients with essential hypertension.
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Affiliation(s)
- Yiqun Wu
- Department of Epidemiology and Biostatistics, Peking University Health Science Center, Beijing, China
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Neutel JM, Mancia G, Black HR, Dahlöf B, Defeo H, Ley L, Vinisko R. Single-pill combination of telmisartan/amlodipine in patients with severe hypertension: results from the TEAMSTA severe HTN study. J Clin Hypertens (Greenwich) 2012; 14:206-15. [PMID: 22458741 DOI: 10.1111/j.1751-7176.2012.00595.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This 8-week, randomized, double-blind, controlled study compared efficacy and tolerability of telmisartan/amlodipine (T/A) single-pill combination (SPC) vs the respective monotherapies in 858 patients with severe hypertension (systolic/diastolic blood pressure [SBP/DBP] ≥180/95 mm Hg). At 8 weeks, T/A provided significantly greater reductions from baseline in seated trough cuff SBP/DBP (-47.5 mm Hg/-18.7 mm Hg) vs T (P<.0001) or A (P=.0002) monotherapy; superior reductions were also evident at 1, 2, 4, and 6 weeks. Blood pressure (BP) goal and response rates were consistently higher with T/A vs T or A. T/A was well tolerated, with less frequent treatment-related adverse events vs A (12.6% vs 16.4%) and a numerically lower incidence of peripheral edema and treatment discontinuation. In conclusion, treatment of patients with substantially elevated BP with T/A SPCs resulted in high and significantly greater BP reductions and higher BP goal and response rates than the respective monotherapies. T/A SPCs were well tolerated.
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Affiliation(s)
- Joel M Neutel
- Orange County Research Center, Tustin, CA 92780, USA.
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