Despite the huge amount of money and effort that goes into developing drugs, they can become ineffective if not taken properly.
Non-compliance rates for patients prescribed medication for chronic conditions can reach approximately 50%, as they may skip doses or take them at the wrong time.
This is the main reason why drugs perform poorly in the real world compared to when tested in carefully controlled trials where adherence tends to be higher.
Aside from wasted spending on medication, the impact of non-compliance is significant. A study published in May found that Nature Review Drug Discovery reported that approximately 125,000 patients die each year in the United States alone.
“Poor adherence is also estimated to cause 10% of all hospitalizations and underlies $100-300 billion in avoidable health care costs annually,” the study states.
That is why the results of a recent trial showing that a drug called dilebesiran is effective in treating blood pressure are of interest.
In contrast to most blood pressure medications that need to be taken daily as a tablet, Gilbesiran only needs to be given as an injection once every 6 months.
“There’s a lot of evidence that if you have a drug delivery regimen that’s effective in a single dose and lasts for three months, six months, or whatever, it’s much better. There is regularity in the amount, and two because the dosage is constant, the dosage is maintained at the correct level,” said Dr Bharat Pankania, senior clinical lecturer at the University of Exeter School of Medicine, UK.
“So long-term medication is a major technological breakthrough, and you can take it and forget it.”
drag holiday
Failure to take tablets properly can be particularly problematic for conditions such as high blood pressure, which are usually asymptomatic to the patient.
“For chronic patients, once they’ve been successfully treated and are asymptomatic, they tend to think, ‘I’m feeling better, why should I be on medication?’ is well known as,” said Professor Oscar Della Pasqua, Professor of Clinical Pharmacology and Therapeutics at University College London.
“Hypertensive patients have no symptoms, so they either think, ‘Let’s stop taking the medicine,’ or stop taking the medicine if necessary, or if there is a gap in the dose, they don’t have a new prescription, so they don’t take the medicine.” to the pharmacy – we call it a drug holiday.
“Overall, this fluctuating pattern of adherence can lead to potential complications, recurrence of symptoms, and more.”
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“With high blood pressure, the complication is an increased risk of stroke, potentially dire consequences for the patient, and potentially higher costs for health care providers,” said Professor Della Pasqua.
the patient stops taking the drug
There are many reasons why patients do not take their drugs as they should.
2011 review paper Mayo Clinic Minutes He noted that some causes are patient-related, including lack of understanding of drugs and lack of involvement in treatment decision-making.
Unpleasant side effects may cause patients to stop taking the drug.
Other reasons may be that your doctor prescribes a complicated treatment regimen or doesn’t adequately explain side effects. Dealing with multiple doctors can also reduce adherence.
“Believing that non-adherence is ‘fault’ on the patient is an uninformed and destructive model that is best abandoned,” the study authors wrote.
Some patients have diseases that make them less likely to take medication. Alzheimer’s disease patients are also among those likely to not adhere to treatment regimens, with noncompliance rates estimated to be between 17 percent and 100 percent. People with psychosis are also less likely to take medication.
“Many people with psychosis have erratic lifestyles and erratic behavior. It’s not that they’re bad people, it’s the way they’re sick,” Pancania said.
last longer
In some cases, the answer is a drug given as a continuous injection that administers a liquid that slowly releases the drug. For antipsychotics, the patient may receive injections once every few weeks, or less frequently.
Depot injections last about 3 months for birth control and may be given for a variety of other purposes, such as as long as 6 months to fight prostate cancer.
In addition to improving medication adherence, reducing the frequency of injections and infusions also provides opportunities for healthcare professionals to see patients.
“That’s where you combine the intervention with follow-up of the patient’s condition,” says Professor Della Pasqua.
“This allows us to have very regular interactions with our health professionals, as visits with our primary care physician or nurse are coordinated.”
Just as providing long-lasting drugs reduces the number of doses taken, combining vaccines can also reduce the number of injections needed.
This is often done with pediatric vaccines such as measles, mumps, and rubella vaccines. In some cases, one injection can prevent him from as many as six diseases.
However, infrequently administered drugs may have downsides.
Dosage adjustments become difficult after months of injections. Using drugs to treat high blood pressure may put the patient at risk of experiencing low blood pressure.
Improved medication adherence is often seen as a benefit of drugs that don’t need to be taken frequently, but Dr Andrew Friedman, an infectious disease researcher at Cardiff University, UK, has identified a pitfall.
“If you don’t like taking your medicine, and you forget to take your semi-annual dose, you’re not taking your medicine at all,” Dr. Freeman says.
“If you forget to take your blood pressure medicine several times a day, it will be less of a problem.”
Updated: Aug 3, 2023, 5:35 AM
