Innovation brings new drugs to the market every month, from small molecules to biologics, and from off-the-shelf medications to personalised therapeutics. These medications, however, are only effective if the patients take them as they are prescribed: [1]
· In a US study, only 72% of new prescriptions were filled
· In a UK study, non-adherence in patients 75 and older was 25% at four weeks
· Ina global study, non-adherence of hypertension medication was 27-40%
Non-adherence has an impact on immediate symptoms, and on long-term disease management, for example potentially leading to increase rates of hospitalization and death. This affects patients and families, and increases costs for healthcare providers. [1]
How drugs are dosed, from ease of administration to packaging, plays an important role in adherence – if the packaging is hard to open, if the drug regimen is onerous and requires many pills or frequent trips to the hospital, or if the oral therapeutics taste unpleasant, patients are less likely to start and maintain their treatment.
Patient-centricity and dosage forms
Patient-centricity has been defined as: ‘Putting the patient first in an open and sustained engagement of the patient to respectfully and compassionately achieve the best experience and outcome for that person and their family.’ [2, 3]
There are a variety of factors that can improve the patient-centricity of pharmaceutical drug product design, and the process needs to begin with engaging with patients and carers to find out what they actually need, and involving them in the drug design and development process, from clinical trials, through formulation to packaging design. This will differ according to the issues faced by each population, for example, both older people and paediatric patients may have issues with swallowing medications. Older patients can have declines in motor function, cognition and visual acuity, and younger patients may need different doses according to body weight and age. [4]
There are many factors involved in adherence failures: [1, 5]
· Patient-related factors
o Age, gender, symptoms (or lack of), beliefs, engagement
· Treatment-related factors
o Pill burden, treatment complexity, tolerability profile of drugs, dosing frequency, portability and discretion of dosing
· Condition-related factors
o Comorbidities, type and severity of the disease, disabilities
· Socio-economic environment
o Education, affordability of treatment
· Health care system
o Access to care or drug reimbursement
o Relationship and communication with healthcare professionals
In a study based at a community pharmacy, oral once-daily medications were preferred by respondents, and high numbers of drugs or frequency of administration were associated with medication discontinuation. [6] The benefits of packaging improvements have also been shown in studies and meta-analyses. [4]
Reducing dose complexity
People, especially those with two or more conditions, may need to take a number of drugs at different times. This particularly affects younger people in at risk populations, and older people, and can lead to issues with adherence.
Sustained- and extended-release oral formulations, including gastroretentive formulations, allow oral drugs to be taken less frequently. Long-acting parenteral forms can be injected or implanted, releasing drugs over days, weeks or even months. [5, 7]
Fixed dose combinations of drugs that are commonly used together make it easier to take the right drug at the right time, particularly for conditions such as cardiovascular disease that commonly require more than one medication. Other examples include antiviral drugs for hepatitis C and HIV. Bright colours, colour combinations and shapes make tablets and capsu...
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