Bots Michiel L, Lafeber Melvin
Universitair Medisch Centrum Utrecht, Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde.
Contact: M.L. Bots (
Ned Tijdschr Geneeskd. 2018 Dec 5;162:D3636.
Cardiovascular polypills or fixed-dose combination (FDC) therapy have been advocated to improve treatment and prevention of cardiovascular disease since 2003. Yet, it is still used infrequently in current practice. This is in contrast to the widespread use of fixed-dose drug combinations for HIV, tuberculosis, and malaria worldwide. Over the past 15 years, evidence from studies in patients with elevated cardiovascular risk or manifest cardiovascular disease has become available, showing that FDC therapy is a strategy which improves adherence, lowers risk factor levels better than usual care, improves adherence to treatment goals, considerably lowers daily intake of pills, and simplifies drug regimens. Furthermore, patients uniformly indicate that this type of therapy is preferred over prescription of individual pills. Also, FDC therapy is reimbursed. Yet, in the Netherlands, only a small percentage of patients is prescribed a fixed dose combination pill. This raises the question what the underlying barriers are to adoption in clinical practice: is it availability, willingness, awareness, or a combination of factors?
自2003年以来，心血管复方制剂或固定剂量联合（FDC）疗法一直被提倡用于改善心血管疾病的治疗和预防。然而，在当前临床实践中其使用频率仍然较低。这与固定剂量药物组合在全球范围内广泛用于治疗艾滋病毒、结核病和疟疾形成了鲜明对比。在过去15年中，针对心血管风险升高或已患心血管疾病患者的研究已有证据表明，FDC疗法是一种能提高依从性、比常规治疗更好地降低危险因素水平、提高对治疗目标的依从性、大幅减少每日服药量并简化药物治疗方案的策略。此外，患者一致表示比起单独开药，他们更倾向于这种治疗方式。而且，FDC疗法是可报销的。然而，在荷兰，只有一小部分患者被开具固定剂量组合药丸。这就引发了一个问题，即在临床实践中采用该疗法的潜在障碍是什么：是可用性、意愿、认知，还是多种因素的综合？
