Fixed-dose combinations improve medication compliance: a meta-analysis.
BACKGROUND
Compliance with treatment is a sine qua non for successful treatment of chronic conditions like hypertension. Fixed-dose combinations are designed to simplify the medication regimen and potentially improve compliance. However the data on comparison of fixed-dose combination with free-drug regimen to improve patient's medication compliance is limited.


METHODS
We conducted a MEDLINE search of studies using the words fixed-dose combinations, compliance and/or adherence. The inclusion criteria were studies which involved fixed-dose combination versus free-drug components of the regimen given separately. Only studies which reported patient's compliance were included.


RESULTS
Of the 68 studies on fixed-dose combinations, only 9 studies fulfilled the inclusion criteria. Two studies were in patients with tuberculosis, 4 in the hypertensive population, 1 in patients with human immunodeficiency virus (HIV) disease and 2 in the diabetic population. A total of 11,925 patients on fixed-dose combination were compared against 8317 patients on free-drug component regimen. Fixed-dose combination resulted in a 26% decrease in the risk of non-compliance compared with free-drug component regimen (pooled relative risk [RR] 0.74; 95% confidence interval [CI], 0.69-0.80; P <.0001). There was no evidence of heterogeneity in this analysis (chi(2)=14.49, df=8; P=.07). A subgroup analysis of the 4 studies on hypertension showed that fixed-dose combination (pooled RR 0.76; 95% CI, 0.71-0.81; P <.0001) decreased the risk of medication non-compliance by 24% compared with free-drug combination regimen.


CONCLUSIONS
Fixed-dose combination decreases the risk of medication non-compliance and should be considered in patients with chronic conditions like hypertension for improving medication compliance which can translate into better clinical outcomes.
Bangalore
Sripal
S
Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital and Columbia University, New York, NY 10025, USA.
Kamalakkannan
Gayathri
G
Parkar
Sanobar
S
Messerli
Franz H
FH
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; D000995:Antitubercular Agents / Q000008:administration & dosage; D002908:Chronic Disease / Q000188:drug therapy*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology; D019468:Disease Management; D004338:Drug Combinations; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D008875:Middle Aged; D010349:Patient Compliance; D019338:Polypharmacy; D014376:Tuberculosis / Q000188:drug therapy
D019380:Anti-HIV Agents; D000959:Antihypertensive Agents; D000995:Antitubercular Agents; D004338:Drug Combinations; D007004:Hypoglycemic Agents