Remembering to take a cocktail of medication each day can be effortful for chronic condition sufferers, especially when certain pills come with irregular times and dosages. Scientists may help ameliorate the problem by introducing a “polypill,” an all-in-one capsule that delivers a person’s medication in one fell swoop.
Tests of the polypill have so far been incredibly effective among cardiovascular disease sufferers, who, as part of the study, took a combination of aspirin and drugs for cholesterol and blood pressure to treat their condition. Participants were far more likely to take their medication when it came as one pill.
"The general advantage is that everything is all in one medication," said Dr. Gerald Fletcher, a spokesman for the American Heart Association, who was not involved in the study. "Patients who have to take a dozen pills at a time tend to have a hard time remembering to take them."
The New Spoonful Of Sugar?
The study, published in JAMA, recruited 2,004 people with cardiovascular disease in the United Kingdom, the Netherlands, Ireland, and India. Many of the participants had already experienced heart attack or stroke, and those who hadn’t were considered high-risk because of high blood pressure, high cholesterol, or smoking habits. Subjects either received the polypill — containing a mix of statin for cholesterol control, a low blood pressure drug, and an antiplatelet to reduce blood clotting — or were prescribed their normal regimen of individual meds.
The results overwhelmingly convinced researchers of the method’s effectiveness in encouraging people to take their heart medication. After the 15-month testing period, more than 86 percent of people on the polypill continued taking their medication, compared to just under 65 percent of those taking the individual drugs.
But what surprised researchers even more were the people in a group singled out as especially high-risk for not taking their medication. Rates shot up from 23 percent to 77 percent as a result of the polypill. Overall, people taking the polypill had lower blood pressure and lower cholesterol than those on individual pills.
"That's outrageous, in terms of improvement," said Dr. David May, chair of the board of governors for the American College of Cardiology, who lauded the study for its contrast with individual medications — a trait of polypill studies that he said has long been ignored in tests of efficacy.
Challenges To Be Faced
One of the benefits of separate medication is a person can discontinue one without having to stop taking another, or several. If a person experiences muscle pain from the statins she’s taking, she can isolate the one medication and tell her doctor, who can then lower the dosage or prescribe alternate treatment. With a polypill, this process is much harder. Each medication gets taken with several others, making differentiating between potential side effects near impossible.
One also has to consider the logistics of taking multiple pills, as not all medication comes with the same requirements.
"Some medications need to be taken at night. In this particular study, the statin drug and the blood pressure drug usually need to be taken at night," Fletcher said. "Antiplatelets are often taken in the morning. That's a slight disadvantage for the polypill."
Bringing the polypill to the U.S. doesn’t mean perfecting these drawbacks. For the time being, Fletcher added, a polypill containing only statin and aspirin could work well, as they are both generics. "The more complex the pill, the longer it will take," he said.
Fletcher’s work highlights the basic importance of taking medication in the first place. Medical science can make great leaps forward in its pharmaceuticals, but without the proper adherence to prescribed medication, the advances are moot.
"The simplification of the delivery of care we provide to our patients is a significant part of the improvement we can gain by this type of strategy," May agreed. "Oftentimes we become enamored with the idea of how much improvement we get with this or that medication, on top of the other drugs a patient has been prescribed. The short answer is, if they don't take it, you don't get any improvement."
Source: Gaziano J. Progress With the Polypill? Journal of the American Medical Association. 2013.