A new “polypill” that can combine the effects of different heart medications has been found to have a higher adherence rate than multiple single treatments, something that potentially could save lives.
After a heart attack, patients are routinely prescribed several different drugs to try to prevent another heart attack from happening. The drug regimen can be incredibly burdensome to the patient who may in some cases have to take in excess of 10 pills every day, sometimes at different points during the day or in different combinations in order to ensure that their treatment regime remains effective.
The kinds of drugs that might be prescribed include tablets to cut bad cholesterol, drugs to improve blood flow, medicines to help stop dangerous blood clots and in some cases drugs that are known as beta-blockers that can slow the heart if it has an abnormal rhythm.
As you can imagine, sticking to that drug treatment can be difficult, and patients may sometimes stray from that plan. This might be because they’ve forgotten their tablets or when they are meant to take them, or because they feel the regimen is a burden that is simply too much. Depression and other factors may also contribute to not following a treatment program. Obviously, this puts the patient at risk of another heart attack or cardiac event. However, new data suggests that prescribing a polypill that combines the effects of several medications into just one pill could, for those over 50 years of age, make a real difference.
The pill, which has been approved in a number of European countries like Spain and Greece, is known as Trinomia and was most recently tested by researchers at Mount Sinai Heart Hospital in New York. The test involved more than 2,000 heart attack survivors from across Spain, Italy, Argentina, Brazil and Paraguay. Unsurprisingly, the first phase of this study found that those taking a lot of pills, and those who had to adhere to complicated treatment plans involving taking certain pills at different times of the day, were less likely to comply with the medical advice than they had been given.
Then, almost 700 patients who had to take three types of drugs a day were asked to participate in a second trial. Part of that group stayed on the three-pills-a-day regime, while the other half were given the polypill that combined all three. Only 84 percent of the three-a-day group were able to stick to the regime for the full nine month trial period, while the polypill achieved a 92 percent compliance rate. That might not sound like a massive difference, but when we’re talking about possibly preventing heart attacks, every percentage point increase is important.
This second phase of the study is ongoing and further research will assess if there are any differences in how the polypill affects blood pressure, blood cholesterol and general safety, as well as the overall costs of the polypill compared to the separate treatment regimes, but early indications remain positive.
Lead researcher Dr. Valentin Fuster is quoted as saying that a lack of adherence to treatment plans has caused a “pandemic” in heart disease and that tackling it with innovative solutions like this, even if they don’t actually offer new medicines but better and easier ways for people to take their medication, is key.”The idea of using a polypill for cardiovascular disease (CVD) prevention has gained increasing momentum because it could increase adherence and therefore contain the progression of CVD. [It would] simplify healthcare delivery, improve cost-effectiveness, support the comprehensive prescription of evidence-based cardioprotective drugs, and reach underdeveloped regions of the world.”
The effectiveness of the drug will be examined in further randomized trials, primarily to assess whether this greater adherence rate translates to a meaningful reduction in the number of future cardiac events, but early signs are positive.
The polypill itself isn’t a new idea. Patients with other illnesses and conditions that require a large number of medications, such as HIV and certain mental health treatments, have also been shown to find it easier to stick to their drug regimes if at least some of their pills are combined into polypills. The polypill does have its downsides, though. For instance, it hinges on fixed dose delivery of medications and so a doctor couldn’t tailor the medications based on a patient’s responses to the pill. Obviously, this might rule out some patients and might not be useful in the early stages of treating a condition when there is a certain amount of trial and error in trying to find a level of medication that works for the individual.
However, as a maintenance regime the polypill is enticing, so this latest research is very welcome as a potential step forward in the battle against cardiovascular health problems.
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