Treatment with Free Triple Combination Therapy of Atorvastatin, Perindopril, Amlodipine in Hypertensive Patients: A Real
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ORIGINAL ARTICLE
Treatment with Free Triple Combination Therapy of Atorvastatin, Perindopril, Amlodipine in Hypertensive Patients: A Real‑World Population Study in Italy Valentina Perrone1 · Chiara Veronesi1 · Marco Gambera2 · Giulio Nati3 · Francesco Perone4 · Paola Fausta Tagliabue5 · Luca Degli Esposti1 · Massimo Volpe6,7 Received: 31 May 2019 / Accepted: 31 July 2019 © Italian Society of Hypertension 2019
Abstract Introduction Polytherapy is often required to treat the comorbidity of hypertension and hyperlipidemia. Fixed-dose coformulation, rather than free combinations, simplifies medication taking and also improves adherence to medication, which is the key for a successful management of these conditions. Aim To determine the number of patients potentially eligible for treatment with triple fixed-dose atorvastatin/perindopril/ amlodipine (CTAPA), and to estimate if an unmet medical need exists among CTAPA free combination treated patients. Methods This observational retrospective study was based on administrative databases of 3 Italian Local Health Units. The cohort comprised adult patients with at least one prescription of amlodipine and perindopril (either as free combination or co-formulated) and atorvastatin during 2014. Follow-up period started on the date of prescription of the 3 molecules (index date) and lasted 1 year. Adherence to CTAPA was analyzed during follow-up, by using the proportion of days covered (PDC). Results 2292 patients (9.1 per 10,000 beneficiaries) had a prescription for CTAPA as free combination. Only 1249 (54.5%) were adherent to the therapy (PDC ≥ 80%); among them, a small percentage required dosage modification. The number of patients with CTAPA increased during the study period. Discontinuation of drugs prescribed the year before interested 582 patients in 2014, and 522 in 2015. Considering the Italian national population (n = 60,782,668), it was estimated that 69,542 hypertensive patients could be eligible for fixed-dose CTAPA during 2014. Conclusions Real-world analysis among patients with free combination therapy can be applied to estimate the eligible population for fixed combination, and to evaluate the appropriateness of their prescriptions. Moreover, fixed-dose CTAPA could effectively improve adherence, which was calculated to be low in the free combination cohort. Keywords Single pill fixed combinations · Atorvastatin/perindopril/amlodipine · Real-world setting
* Valentina Perrone [email protected] 1
Health Economics and Outcomes Research, Clicon S.r.l., Via Salara, 36, 48121 Ravenna, Italy
2
Local Pharmaceutical Service, Bergamo Local Health Authority, Bergamo, Italy
3
Italian Society of General Practice, Roma, Italy
4
Local Health Unit, Caserta, Italy
5
General Practitioner of Agenzia di Tutela e Salute della provincia di Bergamo, Bergamo, Italy
6
Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant’Andrea Hospital, Rome, Italy
7
IRCCS Neuromed, Pozzilli, Italy
1 Introducti
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