The case for single pill combinations

Düsing, Rainer

doi:10.1185/03007995.2014.965776

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…This may be due to the low adherence rates to statin therapy 1 . This interpretation would fit in well with polypharmacy being more common in the mortality group 2 . In turn, the latter observation suggests the need to decrease the number of administered drugs by prescription reviews and use of combination formulations 2 .…”

supporting

confidence: 73%

Off target effects of statins shape total mortality?

Athyros

Katsiki

Karagiannis

2016

Journal of Drug Assessment

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supporting

confidence: 73%

Off target effects of statins shape total mortality?

Athyros

Katsiki

Karagiannis

2016

Journal of Drug Assessment

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“…The rationale being that FDCs of lower dose combinations lower blood pressure more rapidly than monotherapy, reduce side effects and are associated with higher adherence and persistence. 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

Prior experience with cardiovascular medicines predicted longer persistence in people initiated to combinations of antihypertensive and lipid-lowering therapies: findings from two Australian cohorts

Bartlett¹,

Pratt²,

Roughead³

2018

PPA

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PurposeMany studies of persistence involving fixed dose combinations (FDCs) of cardiovascular medicines have not adequately accounted for a user’s prior experience with similar medicines. The aim of this research was to assess the effect of prior medicine experience on persistence to combination therapy.Patients and methodsTwo retrospective cohort studies were conducted in the complete Pharmaceutical Benefits Scheme prescription claims dataset. Initiation and cessation rates were determined for combinations of: ezetimibe/statin; and amlodipine/statin. Initiators to combinations of these medicines between April and September 2013 were classified according to prescriptions dispensed in the prior 12 months as either: experienced to statin or calcium channel blocker (CCB); or naïve to both classes of medicines. Cohorts were stratified according to formulation initiated: FDC or separate pill combinations (SPC). Cessation of therapy over 12 months was determined using Kaplan–Meier survival analysis. Risk of cessation, adjusted for differences in patient characteristics was assessed using Cox proportional hazard models.ResultsThere were 12,169 people who initiated combinations of ezetimibe/statin; and 26,848 initiated combinations of amlodipine/statin. A significant proportion of each cohort were naïve initiators: ezetimibe/statin cohort, 1,964 (16.1%) of whom 81.9% initiated a FDC; and amlodipine/statin cohort, 5,022 (18.7%) of whom 55.4% initiated a FDC. Naïve initiators had a significantly higher risk of ceasing therapy than experienced initiators regardless of formulation initiated: ezetimibe/statin cohort, naïve FDC versus experienced FDC HR=3.0 (95% CI 2.8, 3.3) and naïve SPC versus experienced SPC HR=4.4 (95% CI 3.8, 5.2); and amlodipine/statin cohort naïve FDC versus experienced FDC HR=2.0 (95% CI 1.8, 2.2) and naïve SPC versus experienced SPC HR=1.5 (95% CI 1.4, 1.6).ConclusionPrescribers are initiating people to combinations of two cardiovascular medicines without prior experience to at least one medicine in the combination. This is associated with a higher risk of ceasing therapy than when combination therapy is initiated following experience with one component medicine. The use of FDC products does not overcome this risk.

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The case for single pill combinations

Cited by 2 publications

References 7 publications

Off target effects of statins shape total mortality?

Off target effects of statins shape total mortality?

Prior experience with cardiovascular medicines predicted longer persistence in people initiated to combinations of antihypertensive and lipid-lowering therapies: findings from two Australian cohorts

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