Key result
Fixed-dose combinations and uptitration strategies had higher odds of adherence than switching, with up to 26% higher odds for FDCs in patients with prior poor adherence (P<.05).
Cohort (n=5,998)
FDCs and uptitration may associate with better adherence than switching; hypothesis-generating and requires prospective trials before practice change.
Data on the long-term outcomes of the use of fixed-dose combinations (FDCs) or free-pill combinations (FPCs), titration of doses, and switching are currently unavailable for identifying a preferred strategy for adherence. In the lack of these evidences, adherence can be a useful guiding criteria. The authors conducted a retrospective cohort study using the BlueCross BlueShield of Texas (2008-2012) database to compare adherence among 5998 patients who received treatment modifications (TMs). Results of the propensity score-adjusted model indicate that FDC and uptitration strategies have higher odds of adherence compared with the switch strategy (P<.05). Among patients with a history of poor adherence, the odds of adherence were up to 26% higher for the FDC strategy compared with alternative strategies (P<.05). Factors including age, number of comedications, first-line drug class, and health services utilization are associated with adherence. In conclusion, FDCs should be prioritized for TM, particularly if the patient has a history of poor adherence.
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Sonawane et al. (2016) conducted a cohort in Hypertension (n=5,998). Fixed-dose combinations (FDCs) and uptitration strategies vs. Switch strategy was evaluated on Adherence (26% higher odds, p=<.05). Fixed-dose combinations and uptitration strategies had higher odds of adherence than switching, with up to 26% higher odds for FDCs in patients with prior poor adherence (P<.05).
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