Fixed‐dose combination therapy to reduce the growing burden of cardiovascular disease in low‐ and middle‐income countries: feasibility and challenges

Nansseu, Jobert Richie; Tankeu, Aurel T.; Kamtchum‐Tatuene, Joseph; Noubiap, Jean Jacques

doi:10.1111/jch.13162

Cited by 6 publications

(3 citation statements)

References 39 publications

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“…The present study clearly identified some of these factors, perhaps inferring that if specific interventions targeting each of these factors are implemented, the projected overburdened picture of CVD would be efficaciously mitigated in the Cameroonian context and beyond. Moreover, the debate of initiating a pharmacological treatment for the prevention of CVD among high-risk populations is still ongoing; a polypill made of an antihypertensive drug, a statin and inconstantly a low-dose anticoagulant is suggested to be initiated in high-risk primary prevention of CVD, but the evidence supporting this recommendation is very weak 35–37…”

Section: Discussionmentioning

confidence: 99%

Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon

Nansseu¹,

Assah

Petnga

et al. 2019

BMJ Open

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ObjectiveTo describe the global cardiovascular disease (CVD) risk distribution in a young adult-aged population living in Yaoundé, Cameroon and depict factors likely influencing this risk distribution.DesignA cross-sectional study between May and July 2017.SettingThe University of Yaoundé I, Cameroon.ParticipantsAny university student aged 18 years and above, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study.Primary and secondary outcome measuresThe global risk of CVD was measured with the non-laboratory-based INTERHEART Modifiable Risk Score.ResultsA total of 949 participants (54% males) were recruited; the median age was 23 (IQR 21–26) years. The CVD risk varied between 2 and 21, with a median of 9 (IQR 7–12); 51.2% of students had a low risk of CVD, 43.7% had a moderate risk and 5.1% presented a high risk of CVD. The number of years since first registration at the university (β=0.08), history of sudden death among biological parents (β=1.28), history of hypertension among brothers/sisters (β=1.33), history of HIV infection (β=4.34), the Alcohol Use Disorder Identification Test-Consumption score (β=0.13), regular exposure to firewood smoke (β=1.29), eating foods/drinks with too much sugar ≥1 time/day (β=0.96), eating foods/snacks with too much oil ≥3 times/week (β=1.20) and eating dairy products≥1 time/day (β=0.61) were the independent factors likely influencing participants’ global risk of CVD.ConclusionAlmost 50% of participants had moderate or high risk of CVD. Specific interventions targeting major CVD risk factors should be put in place among young adults to prevent or reduce this upcoming overburdened picture of CVD.

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Section: Discussionmentioning

confidence: 99%

Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon

Nansseu¹,

Assah

Petnga

et al. 2019

BMJ Open

Self Cite

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“…Attention in recent years has turned to the development and availability of a 'polypill', which is an oral tablet containing low dose aspirin, a statin, and at least one anti-hypertensive medicine to prevent CV events [195]. Such a pill is potentially seen as an affordable and cost-effective for the prevention of CVD especially in LMICs if the polypill was made available based on current public sector prices [38,40,42,143,[196][197][198][199]. Polypills have also been shown to enhance adherence, are well tolerated and reduce risk factors in both primary and secondary prevention [87,196,[200][201][202].…”

Section: Cardiovascular Diseases (Cvd)mentioning

confidence: 99%

Fixed dose drug combinations – are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries

Godman

McCabe

Leong

2020

Expert Review of Pharmacoeconomics & Outcomes Research

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Introduction: There are positive aspects regarding the prescribing of fixed dose combinations (FDCs) versus prescribing the medicines separately. However, these have to be balanced against concerns including increased costs and their irrationality in some cases. Consequently, there is a need to review their value among lower-and middle-income countries (LMICs) which have the greatest prevalence of both infectious and noninfectious diseases and issues of affordability. Areas covered: Review of potential advantages, disadvantages, cost-effectiveness, and availability of FDCs in high priority disease areas in LMICs and possible initiatives to enhance the prescribing of valued FDCs and limit their use where there are concerns with their value. Expert commentary: FDCs are valued across LMICs. Advantages include potentially improved response rates, reduced adverse reactions, increased adherence rates, and reduced costs. Concerns include increased chances of drug:drug interactions, reduced effectiveness, potential for imprecise diagnoses and higher unjustified prices. Overall certain FDCs including those for malaria, tuberculosis, and hypertension are valued and listed in the country's essential medicine lists, with initiatives needed to enhance their prescribing where currently low prescribing rates. Proposed initiatives include robust clinical and economic data to address the current paucity of pharmacoeconomic data. Irrational FDCs persists in some countries which are being addressed.

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“…Table 2. Fixed-dose combination products for the prevention of cardiovascular disease that adhere strictly to the original polypill definition (adapted from [14,25,37,64]).…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Fixed-Dose Combination Formulations in Solid Oral Drug Therapy: Advantages, Limitations, and Design Features

Wilkins,

Hamman,

Hamman

et al. 2024

Pharmaceutics

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Whilst monotherapy is traditionally the preferred treatment starting point for chronic conditions such as hypertension and diabetes, other diseases require the use of multiple drugs (polytherapy) from the onset of treatment (e.g., human immunodeficiency virus acquired immunodeficiency syndrome, tuberculosis, and malaria). Successful treatment of these chronic conditions is sometimes hampered by patient non-adherence to polytherapy. The options available for polytherapy are either the sequential addition of individual drug products to deliver an effective multi-drug regimen or the use of a single fixed-dose combination (FDC) therapy product. This article intends to critically review the use of FDC drug therapy and provide an insight into FDC products which are already commercially available. Shortcomings of FDC formulations are discussed from multiple perspectives and research gaps are identified. Moreover, an overview of fundamental formulation considerations is provided to aid formulation scientists in the design and development of new FDC products.

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Fixed‐dose combination therapy to reduce the growing burden of cardiovascular disease in low‐ and middle‐income countries: feasibility and challenges

Cited by 6 publications

References 39 publications

Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon

Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon

Fixed dose drug combinations – are they pharmacoeconomically sound? Findings and implications especially for lower- and middle-income countries

Fixed-Dose Combination Formulations in Solid Oral Drug Therapy: Advantages, Limitations, and Design Features

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