The Polypill Comes of Age

The polypharmacy is not the poly pill. Polypharmacy is the use of multiple medications by a single patient, which can be ill-advised and result in medication interactions. Two decades ago, the polypill was recommended. One tongue-in- cheek proposal was to add vastatin to the drinking water because of its ability to reduce cardiovascular disease. The scattershot approach would have resulted in over-medication of low-risk patients who didn't need treatment and under-medication of those who did.

Wald and Law came up with the idea of a polypill to prevent cardiovascular disease. They proposed two things. They said that a poly pill would reduce cardiovascular events by 80%. They wanted to use a fixed-dose combination.

The idea of using a fixed-dose combination to improve compliance was overshadowed by a heated debate over who should be treated. It has been shown that giving medication to everyone with cardiovascular disease improves outcomes.

There are many studies that show the same or even improved risk factor control with the poly pill. Previous trials were not able to show the effect of poly pills on cardiovascular outcomes. In the September 15, 2022, issue of The New England Journal of Medicine, there is a new study called the SECURE trial.

Secondary prevention of cardiovascular disease in the elderly is calledSECURE. It was an open-label, multinational, randomized, controlled trial comparing a poly pill-based strategy to usual care in patients with recent myocardial infarction. 2500 old people were followed for 3 years. There were more major cardiovascular events in the usual care group than in the poly pill group. There were high rates of evidence based therapies in the usual care group. It was confirmed that the strategy was safe.

There were six different versions of the polypill that physicians could choose from, with 2 different doses of atorvastatin and 3 different doses of ramipril. The majority of patients were taking a second drug. Is it a good idea to add that to the polypill to make it easier to take the pill?

A good idea whose time has arrived.

The polypill has a role to play in secondary prevention. Compliance and outcomes are improved by it. It seems to me that a clever marketing campaign can create a blockbuster new drug for a lucky company.