Lawrence Blonde1, Zinnia T San Juan2, Peggy Bolton1. 1. Department of Endocrinology, Diabetes and Metabolic Diseases, Ochsner Medical Center, New Orleans, Louisiana. 2. Department of Internal Medicine, Division of Endocrinology, Texas Tech University Health Sciences Center, El Paso, Texas.
Abstract
OBJECTIVE: The management of type 2 diabetes mellitus (T2DM) often requires combinations of antihyperglycemic medications with complementary mechanisms of action. Inadequate adherence to combination therapy, possibly related to pill burden (greater number of pills and higher administration frequency) and poor tolerability, may lead to suboptimal clinical outcomes. One potential means of addressing these problems is the use of fixed-dose combinations (FDCs) that simplify the treatment regimen by reducing pill burden compared with the same combination delivered as separate pills. The present study evaluates the efficacy and tolerability of FDCs in the treatment of T2DM patients and provides an overview of dosing, costs, and adherence. METHODS: A review of FDCs, with particular attention to those that contain metformin extended-release (XR) and allow once-daily dosing. RESULTS: Many FDCs contain metformin as one of the component drugs. However, the standard immediate-release (IR) formulation of metformin requires twice-daily dosing and may have tolerability problems related to adverse gastrointestinal (GI) effects. The XR formulations of metformin can be administered once daily and have been shown to reduce the occurrence of GI effects frequently observed with metformin IR; consequently, they may have significant advantages for inclusion in FDCs. The long-term cost-effectiveness of FDCs remains to be fully determined. CONCLUSION: For patients taking metformin, FDCs containing metformin XR offer equivalent efficacy with reduced dose frequency and, potentially, fewer GI events compared with standard IR formulation, as well as a reduced number of pills compared with separate-pill regimens. By reducing pill burden and improving tolerability, FDCs may improve adherence.
OBJECTIVE: The management of type 2 diabetes mellitus (T2DM) often requires combinations of antihyperglycemic medications with complementary mechanisms of action. Inadequate adherence to combination therapy, possibly related to pill burden (greater number of pills and higher administration frequency) and poor tolerability, may lead to suboptimal clinical outcomes. One potential means of addressing these problems is the use of fixed-dose combinations (FDCs) that simplify the treatment regimen by reducing pill burden compared with the same combination delivered as separate pills. The present study evaluates the efficacy and tolerability of FDCs in the treatment of T2DM patients and provides an overview of dosing, costs, and adherence. METHODS: A review of FDCs, with particular attention to those that contain metformin extended-release (XR) and allow once-daily dosing. RESULTS: Many FDCs contain metformin as one of the component drugs. However, the standard immediate-release (IR) formulation of metformin requires twice-daily dosing and may have tolerability problems related to adverse gastrointestinal (GI) effects. The XR formulations of metformin can be administered once daily and have been shown to reduce the occurrence of GI effects frequently observed with metformin IR; consequently, they may have significant advantages for inclusion in FDCs. The long-term cost-effectiveness of FDCs remains to be fully determined. CONCLUSION: For patients taking metformin, FDCs containing metformin XR offer equivalent efficacy with reduced dose frequency and, potentially, fewer GI events compared with standard IR formulation, as well as a reduced number of pills compared with separate-pill regimens. By reducing pill burden and improving tolerability, FDCs may improve adherence.
Authors: Magdalena Paczkowska-Walendowska; Szymon Sip; Rafał Staszewski; Judyta Cielecka-Piontek Journal: Int J Environ Res Public Health Date: 2022-03-31 Impact factor: 3.390
Authors: Enrica Menditto; Valentina Orlando; Giuseppe De Rosa; Paola Minghetti; Umberto Maria Musazzi; Caitriona Cahir; Marta Kurczewska-Michalak; Przemysław Kardas; Elísio Costa; José Manuel Sousa Lobo; Isabel F Almeida Journal: Pharmaceutics Date: 2020-01-03 Impact factor: 6.321