Evidence Linking Medication Combinations & Adherence
Fixed-dose combinations and adherence From Bandolier, March 2005; 133-4
This article examines a review1 that covers fifteen trials that, one way or another, investigated the enhancement of adherence by consolidating medication daily medication doses. Those fifteen represented such a mixed bag that the most precise clinical conclusion the authors could reach was “Studies had statistical significance or trends towards better adherence or better clinical outcomes more often than they did not.”
More significantly, the Bandolierwriters note that “there is precious little information, that the trials are in a mixed bunch of conditions (they include TB, leprosy, malaria, hypertension) and settings from less to most developed countries.”
Abandoning the tiny database, the authors posit that there appear to be compliance and clinical outcome advantages to the use of combination doses – most of the time (i.e., when the combinations simplify a evidence-based regimen, not when it combines useful medications with potentially dangerous dugs). Given the additional fact that the higher the number of pills prescribed, the greater the risk of adverse effects, the potential benefit of combinations is clear.
As the authors conclude, in what is one of my all-time favorite statements from a medical journal article,
Commentary
I note a high correlation of high quality medical literature reviews with the use of the word, “daft.”
Footnote
- J Connor et al. Do fixed-dose combination pills or unit-of-use packaging improve adherence? A systematic review. Bulletin of the World Health Organisation 2004 82: 935-939. [back]
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