Anno II – Numero 5 – Gennaio 2021
Comitato scientifico editoriale: Antonio Magi, Pierluigi Bartoletti, Fernando De Benedetto, Giovanbattista Desideri, Francesco Cognetti, Roberto Messina
Editore: Intermedia – Direttore Responsabile: Mauro Boldrini –


Fixed-Dose Combination Medications for Treating Hypertension: A Review of Effectiveness, Safety, and Challenges
Jaejin An, Catherine G Derington, Tiffany Luong, Kari L Olson, Jordan B King, Adam P Bress, Cynthia A Jackevicius

Purpose of review: To summarize the recent evidence on the effectiveness and safety of antihypertensive fixed-dose combination (FDC) medications, and to describe the facilitators and barriers to implementing FDCs in US clinical practice.

Recent findings: Recent clinical practice guidelines include FDC use for treating high BP. Clinical trials in recent years support the use of antihypertensive FDCs including low-dose triple- and quadruple-therapy FDCs. Initiating a low-to-standard dose dual-therapy FDCs showed better BP control than initiating treatment with a standard-dose monotherapy, and triple-therapy FDCs produced better BP control rates than dual-therapy FDCs. Retrospective cohort studies showed that FDCs are associated with increased medication adherence, reduced clinical inertia, decreased time to BP control, and improved cardiovascular outcomes. We further discussed barriers and facilitators of wider implementation of antihypertensive FDCs…Read more

Identifying routine clinical predictors of non-adherence to second-line therapies in type 2 diabetes: A retrospective cohort analysis in a large primary care database
Beverley M., Shields Andrew T., Hattersley Andrew J. Farmer

Funding information: This work was funded by the National Institute for Health Research (NIHR) Programme Grant (RP‐PG‐1214‐20 003). The MASTERMIND (MRC APBI Stratification and Extreme Response Mechanism IN Diabetes) consortium is supported by the Medical Research Council (United Kingdom; MR/N00633X/1). A.T.H. is an NIHR Senior Investigator and Wellcome Trust Senior Investigator. B.M.S. and A.T.H. are supported by the NIHR Exeter Clinical Re‐search Facility. A.J.F. is an NIHR Senior Investigator and is supported by the NIHR Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in any part of the study or in any decision about publication...Read more

Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial
Marcel Bilger, Tina T. Wong, Jia Yi Lee, Kaye L. Howard, Filipinas G. Bundoc, Ecosse L. Lamoureux, Eric A. Finkelstein

Poor adherence to medications is a global public health concern with substantial health and cost implications, especially for chronic conditions. In the USA, poor adherence is estimated to cause 125,000 deaths and cost $US100 billion annually. The most successful adherence-promoting strategies that have been identified so far have moderate effect, are relatively costly, and raise availability, feasibility, and/or scalability issues.

The main objective of SIGMA (Study on Incentives for Glaucoma Medication Adherence) was to measure the effectiveness on medication adherence of a novel incentive strategy based on behavioral economics that we refer to as adherence-contingent rebates. These rebates offered patients a near-term benefit while leveraging loss aversion and regret and increasing the salience of adherence…Read more

Determinants of self-reported adherence to inhaler therapy in patients with chronic obstructive pulmonary disease
Ilaria Aredano, Francesca de Blasio, Paola Berchialla, Luisa Brussino, Caterina Bucca, Paolo Solidoro

Adherence to therapy is crucial for COPD patients, since non-adherence leads to worse quality of life, increased health-care expenditure and poor clinical outcome. The aim of this study was to identify the main determinants of suboptimal adherence to therapy in a cohort of COPD patients.

General information (age, BMI, smoking, comorbidities, education, life style), lung function, exacerbations, symptoms and COPD treatment were collected. Adherence to therapy was assessed by self-reported 4-item Morisky Medication Adherence Scale (MMAS-4), and was related to anthropometric, socio/economic and health status data, obtained by questionnaires (COPD Assessment Test, CAT; Treatment Satisfaction Questionnaire, HRQoL; Katz Index of Independence of Daily Living Activities, Lawton Instrumental Activities of Daily Living Scale)Read more

Societal and Economic Impact of Poor Glaucoma Medication Adherence
Florent Aptel, Andrew Toren

The article by Newman-Casey et al1 (see page 589) highlights the economic importance of adherence to glaucoma medication from a societal perspective. Research into chronic disease management increasingly focuses efforts on the economic arguments for investing in multidisciplinary interventions that improve patient adherence.2 In glaucoma, research studies have examined adherence and have shown, as the authors state, that certain interventions can improve adherence with glaucoma medication regimens. Currently, no particular intervention is recommended because of the low quality of the existing evidence.3
The key finding in this article is the economic benefit to society estimated by the incremental cost-effectiveness ratio per quality-adjusted life year (QALY). The lower the incremental cost-effectiveness ratio, the better value to society in achieving a better health outcome within the population. Using American health care figures, the authors found that achieving glaucoma medication adherence…Read more

Aspects concerning patient adherence to anti-TNFα therapy in psoriasis: A decade of clinical experience
Madalina Mocanu, Mihaela-Paula Toader, Elena Rezus, Tatiana Taranu

Non-adherence to psoriasis treatment has an important impact in controlling chronic disease evolution and the occurrence of systemic comorbidities. Biologic therapy represents a revolutionary treatment, many of the undesirable psychological and socio-economical consequences of conventional topical or systemic therapies being avoided. Nevertheless, the discontinuation of biological therapy may occur due to facts related to the patient, to the lack of good communication between the patient and the physician or to the adverse or paradoxical reactions. We studied the non-adherence reasons to anti-TNFα agents (Infliximab, Adalimumab, Etanercept) used for treating 84 cases with moderate-severe psoriasis. The results of our study over the past 10 years showed a 76.2% adherence rate, lowest in patients treated with Etanercept (70.9%). Relative to the anti-TNF agent used, the highest adherence rate was recorded in Adalimumab (80.8%), followed by Infliximab (76.5%) and Etanercept (70.9%). We have noticed differences between the rates of adhesion to therapy with different anti-TNFα agents…Read more

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