The Polypill

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This week’s Lancet has an interesting article from The Indian Polycap Study (TIPS), in which investigators tested the efficacy and tolerability of a single pill containing up to FIVE different cardiovascular medications:  a beta-blocker, an ACE-inhibitor, a thiazide diuretic, a statin, and aspirin–with the hopes that this single “one-size-fits-all” pill could one day be used to dramatically cut down the rate of cardiovascular disease in the general population.

More specifically, the group used lower-than-conventional doses of the following medications:  atenolol (50mg), ramipril (5mg), thiazide (25mg), simvastatin (20mg), and aspirin (100mg) in a once-a-day pill.  This was considered a primary prevention trial, so none of the individuals already had cardiovascular disease; in addition, they excluded patients with CKD, severe hypertension (>160/100), or severe hyperlipidemia (LDL>175).  The target group to be tested were relatively healthy individuals with a single cardiovascular risk factor.  People were randomized to one of several groups including the full five-drug “Polypill” compared with a pill containing 1, 2, 3, or 4 of the above drugs in combination.  The primary outcomes were LDL level, blood pressure level, heart rate, degree of antiplatelet effect, and rates of discontinuity of drugs for safety.  
The investigators found (perhaps not surprisingly) that using all three blood pressure drugs at the same time (atenolol, ramipril, and HCTZ) were associated with the best BP-lowering effect.  They also showed (perhaps more surprisingly) that the Polypill containing all five medications did not show an increase in safety/side effect profile, and the authors conclude that giving a “Polypill” such as this represents a viable strategy for primary prevention of heart disease.
What do we think about this?  On the one hand, it could be good news–it’s often difficult to convince patients to take so many different pills, and putting them all together potentially gets around this.  However, there are some potential negative consequences–it is not uncommon to have to take patients off their ACE-inhibitor for brief periods of time, and having a patient on the Polypill would make this more of a hassle for both patient and physician.  It is also not clear what the cost of the medication would be–most of the medications above are available in the generic (cheap) form, but if a drug company puts them together in a single pill, it is possible they could charge whatever they wanted. 
Despite these potentially negative consequences, it’s an interesting idea.  Perhaps one day we will even be able to “custom-make” a single pill combining all of the drugs an individual patient requires into a single pill.  

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