Patient adherence and reimbursement amount for antidiabetic fixed-dose combination products compared with dual therapy among texas medicaid recipients

Hypertension is the leading cause of disability and cardiovascular mortality world-wide. Approximately one-third of the US adult population and over a billion people world-wide have hypertension. Despite increased awareness of hypertension and availability of many effective antihypertensive agents, only one third of patients achieve their target blood pressure (BP). All expert panels now recommend use of combination therapy for stage 2 and higher hypertension and for individuals who are at increased risk of cardiovascular disease (CVD). Amlodipine, a dihydropyridine calcium channel blocker and Valsartan, an angiotensin II receptor (AT1-R) antagonist are widely used antihypertensive agents. Their efficacy in lowering systolic and diastolic BP and reducing CVD events has been demonstrated in several randomized trials. Fixed-dose combination of amlodipine and valsartan (A/V) has been shown to be more effective in lowering BP than monotherapy with either of these agents alone in randomized trials with comparable side effect profile. Approximately 80%-90% of patients with stage 1-2 hypertension receiving A/V fixed-dose combination achieve significant response, defined as a mean sitting diastolic BP < 90 mmHg or > 10 mmHg reduction from the baseline. Subgroup analyses show that A/V fixed-dose combination is equally effective in older individuals (>65), Blacks, in patients with isolated systolic hypertension, and in those who fail monotherapy. Furthermore, A/V fixed-dose combination is well tolerated and simplifies antihypertensive regimen enhancing patient adherence and a better BP control compared to monotherapy.

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Analysis of the Authorized Target Populations for Fixed Dose Combination Products Between 2000 and 2017 Reveals Discrepancies Between EMA’s and FDA’s Views on Initial Dual-Therapy

Therapeutic Innovation & Regulatory Science ◽

10.1007/s43441-019-00057-7 ◽

2020 ◽

Vol 54 (2) ◽

pp. 297-302

Author(s):

Ole Jannik Bjerrum ◽

Sascha Eichendorff ◽

Nada Bassam Alkis

Keyword(s):

Dual Therapy ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Target Populations ◽

Dose Combination

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A perindopril/amlodipin szabad és fix kombinációk egyéves terápiahűsége

Orvosi Hetilap ◽

10.1556/650.2017.30851 ◽

2017 ◽

Vol 158 (36) ◽

pp. 1421-1425

Author(s):

Gábor Simonyi ◽

Tamás Ferenci ◽

Mihály Medvegy ◽

Roland Gasparics ◽

Ervin Finta

Keyword(s):

Survival Analysis ◽

Antihypertensive Therapy ◽

Patient Adherence ◽

Fixed Dose Combination ◽

Fixed Dose ◽

Cardiovascular Risk Reduction ◽

Pharmacy Claims ◽

Dose Combination ◽

One Year ◽

The One

Abstract: Introduction: In management of hypertension patient adherence is one of the most important factors. In hypertension the cardiovascular risk reduction can be reached only by prolonged and effective pharmacotherapy. Aim: To evaluate the persistence of one-year treatment of free and fixed-dose combination of perindopril/amlodipine in hypertension. Method: Information from the National Health Insurance of Hungary prescriptions database on pharmacy claims between October 1, 2012 and September 30, 2013 was analysed. Authors identified patients who filled prescriptions for free and fixed-dose combination of perindopril/amlodipine, prescribed for the first time for hypertension. Patients have not received antihypertensive therapy with similar active substances during the one year before. Apparatus of survival analysis was used, where “survival” was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied. Results: 109,248 patients met the inclusion criteria. Combination antihypertensive therapy with perindopril/amlodipine was started with a free or a fixed-dose combination of these agents in 19,365 and 89,883 patients, respectively. One year persistence rate in patients taking perindopril/amlodipine as a free combination was 27.15%, whereas it was 46.89% in those on the fixed-dose combination. Mean duration of persistence was 177.6 days in patients on the perindopril/amlodipine free, whereas 245.7 days on fixed-dose combination. Actual rate of discontinuation was approximately twice higher with the treatment of free, compared with the use of the fixed-dose combination (hazard ratio =1.94 [95% CI: 1.91–1.98], p<0.001). Orv Hetil. 2017; 158(36): 1421–1425.

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