Fixed-dose combination medications for non-communicable diseases

Abstract

In 2011, the United Nations General Assembly adopted the Political Declaration on Noncommunicable Diseases (NCDs) to acknowledge the threat of the rising non-communicable disease epidemic occurring globally, but predominantly impacting low-income and middle-income countries (LMICs). In response, WHO developed a global monitoring framework to track progress in the prevention and control of major non-communicable diseases—cardiovascular disease, cancer, chronic lung diseases and diabetes—and their key risk factors.1 Part of that framework included nine voluntary goals aiming to achieve a 25% reduction in premature mortality from NCDs by 2025. Three of these goals are relevant to discussions about the use of fixed-dose combination (FDC) medication—25% reduction in raised blood pressure, 50% coverage of drug therapy and counselling, and 80% coverage of essential NCD medications and technology. Currently, despite the availability of a plethora of cheap, effective drugs (including blood pressure–lowering medications, cholesterol-lowering medications and antiplatelet drugs), the majority of people globally at highest risk are not receiving recommended therapy for the prevention of heart attacks and strokes.2 In patients with hypertension, the single leading cause of mortality globally and biggest risk factor for cardiovascular disease generally, only about a third of those with documented hypertension are receiving treatment with only approximately one-half of those treated in high-income countries and about one-quarter in LMICs achieving blood pressure control.3 If WHO goals are to be achieved, clearly novel strategies and a different approach are required. In this context, there is potential for FDC therapy (single medications that contain a combination of two or more active ingredients), implemented as part of a broader health systems approach, to help achieve these goals, particularly in cardiovascular disease. The rationale for using FDCs is well established in communicable diseases such as malaria, tuberculosis and HIV/AIDS where reduction in pill burden, simplification of medication regime and …