In a recent article, Hutchins et al. conducted a systematic review to evaluate the efficacy and safety of fixed-dose combination therapies (FDC) in patients with type 2 diabetes (T2D)Citation1. They concluded that T2D patients treated with FDCT may have better adherence, improved satisfaction, and lower direct medical costs, compared to those treated with loose-pill combination therapies. Similar result was also presented by SchernthanerCitation2.
As we all know, most treatment guidelines recommend monotherapy with metformin as a first-line pharmacological agent. However, monotherapy is often unsuccessful in achieving or maintaining acceptable glycemic control. For example, in the United Kingdom Prospective Diabetes Study, within 3 years following diagnosis, 50% of T2D patients required combination therapy to attain a glycosylated haemoglobin (HbA1c) target of <7%Citation3. Against this background, the earlier combination use of two oral agents is now recognized as an opportunity to achieve glycaemic targets sooner and for longerCitation4. Fixed-dose single-tablet combinations of antidiabetic agents, usually consisting of two or more oral agents with different mechanisms of action, have shown several potential advantages over separate tablets: better glycaemic control, lower incidence of individual drug’s side effects, increased patient compliance and lower cost of therapyCitation5, which may provide a valuable initial treatment choice to T2D patients.
In our clinical practice, there are some similar cases between blood pressure (BP) control and glycaemic control. Recently, several hypertension management guidelines have put combination of two drugs, either as separate prescriptions or in fixed-dose combinations, as first-step treatment when initial BP is in grade 2 or 3 or total cardiovascular risk is high or very highCitation6–8. In fact, the use of combination therapy also has a long tradition in diabetes. However, these combination therapies were usually recommended if monotherapy did not achieve adequate glycaemic control. Based on their special advantages in glycaemic control, combination therapies, especial the fixed-dose single-tablet combinations, represent an attractive alternative for the first step treatment in certain T2D patients requiring substantial glycaemic reduction due to either high initial blood glucose values or cardiovascular risk.
References
- Hutchins V, Zhang B, Fleurence RL, et al. A systematic review of adherence, treatment satisfaction and costs, in fixed-dose combination regimens in type 2 diabetes. Curr Med Res Opin 2011;27:1157-68
- Schernthaner G. Fixed-dose combination therapies in the management of hyperglycaemia in Type 2 diabetes: an opportunity to improve adherence and patient care. Diabet Med 2010;27:739-43
- Turner RC, Cull CA, Frighi V, et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA 1999;281:2005-12
- Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006;29:1963-72
- Bailey CJ, Day C. Fixed-dose single tablet antidiabetic combinations. Diabetes Obes Metab 2009;11:527-33
- Mancia G, De Backer G, Dominiczak A, et al. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007;25:1751-62
- Chiang CE, Wang TD, Li YH, et al. 2010 guidelines of the Taiwan Society of Cardiology for the management of hypertension. J Formos Med Assoc 2010;109:740-73
- Gradman AH, Basile JN, Carter BL, et al. Combination therapy in hypertension. J Am Soc Hypertens 2010;4:42-50