1
|
De Luca L, Di Fusco SA, Iannopollo G, Mistrulli R, Rizzello V, Aimo A, Navazio A, Bilato C, Corda M, Di Marco M, Geraci G, Iacovoni A, Milli M, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gabrielli D, Grimaldi M, Colivicchi F, Oliva F. Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on the simplification of the drug regimen for secondary cardiovascular prevention. Eur Heart J Suppl 2024; 26:ii236-ii251. [PMID: 38784670 PMCID: PMC11110452 DOI: 10.1093/eurheartjsupp/suae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socio-economic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.
Collapse
Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Stefania Angela Di Fusco
- UOC Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, Rome, Italy
| | | | - Raffaella Mistrulli
- Dipartimento di Medicina Clinica e Molecolare, Università degli studi di Roma La Sapienza, Rome, Italy
| | | | - Alberto Aimo
- UOC Cardiologia, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alessandro Navazio
- SOC Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia—IRCCS, Reggio Emilia, Italy
| | - Claudio Bilato
- UOC Cardiologia, Ospedali dell'Ovest Vicentino, Azienda ULSS 8 Berica, Vicenza, Italy
| | - Marco Corda
- SC Cardiologia, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | | | - Giovanna Geraci
- UOC Cardiologia, Ospedale Sant'Antonio Abate, Trapani, Italy
| | - Attilio Iacovoni
- SSD Chirurgia dei Trapianti e del Trattamento Chirurgico dello Scompenso, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Massimo Milli
- Cardiologia Firenze 1 (Ospedali S. Maria Nuova e Nuovo San Giovanni di Dio), Azienda USL Toscana Centro, Firenze, Italy
| | - Vittorio Pascale
- UTIC-Emodinamica e Cardiologia Interventistica, Ospedale Civile Pugliese, Catanzaro, Italy
| | - Carmine Riccio
- U.O.S.D. Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta, Italy
| | | | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli, TO, Italy
| | - Domenico Gabrielli
- Dipartimento Cardio-Toraco-Vascolare, U.O.C. Cardiologia, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Massimo Grimaldi
- U.O.C. Cardiologia-UTIC, Ospedale Miulli, Acquaviva delle Fonti, BA, Italy
| | - Furio Colivicchi
- UOC Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, Rome, Italy
| | - Fabrizio Oliva
- Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare “A. De Gasperis”, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| |
Collapse
|
2
|
Binsaleh NK, Wigley CA, Whitehead KA, van Rensburg M, Reynisson J, Pilkington LI, Barker D, Jones S, Dempsey-Hibbert NC. Thieno[2,3-b]pyridine derivatives are potent anti-platelet drugs, inhibiting platelet activation, aggregation and showing synergy with aspirin. Eur J Med Chem 2017; 143:1997-2004. [PMID: 29129512 DOI: 10.1016/j.ejmech.2017.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 10/19/2017] [Accepted: 11/04/2017] [Indexed: 11/19/2022]
Abstract
Drugs which inhibit platelet function are commonly used to prevent blood clot formation in patients with Acute Coronary Syndromes (ACS) or those at risk of stroke. The thieno[3,2-c]pyridine class of therapeutic agents, of which clopidogrel is the most commonly used, target the P2Y12 receptor, and are often used in combination with acetylsalicylic acid (ASA). Six thieno[2,3-b]pyridine were assessed for in vitro anti-platelet activity; all derivatives showed effects on both platelet activation and aggregation, and showed synergy with ASA. Some compounds demonstrated greater activity when compared to clopidogrel. These compounds, therefore, represent potential novel P2Y12 inhibitors for improved treatment for patients.
Collapse
Affiliation(s)
- Naif K Binsaleh
- School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Catherine A Wigley
- School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Kathryn A Whitehead
- School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK
| | | | | | - Lisa I Pilkington
- School of Chemical Sciences, The University of Auckland, New Zealand
| | - David Barker
- School of Chemical Sciences, The University of Auckland, New Zealand.
| | - Sarah Jones
- School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Nina C Dempsey-Hibbert
- School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK.
| |
Collapse
|
3
|
Koh JS, Park Y, Tantry US, Ahn JH, Kang MG, Kim K, Jang JY, Park HW, Park JR, Hwang SJ, Kwak CH, Hwang JY, Gurbel PA, Jeong YH. Pharmacodynamic effects of a new fixed-dose clopidogrel-aspirin combination compared with separate administration of clopidogrel and aspirin in patients treated with coronary stents: The ACCEL-COMBO trial. Platelets 2016; 28:187-193. [PMID: 27560946 DOI: 10.1080/09537104.2016.1206197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely prescribed regimen to prevent ischemic events in patients undergoing percutaneous coronary intervention (PCI). A fixed-dose combination (FDC) capsule (HCP0911) has been developed to provide dosing convenience and improve adherence. We compared the antiplatelet effects of single daily dose HCP0911 with separate treatment with daily 75 mg clopidogrel plus 100 mg aspirin. This was a randomized, open-label, two-period, crossover, non-inferiority study conducted in stented patients who had been treated for at least 6 months with clopidogrel and aspirin. Thirty patients were randomly assigned to receive either daily 75 mg clopidogrel plus 100 mg aspirin treatment or HCP0911 for 2 weeks and then were crossed over to the other treatment for 2 weeks. Pharmacodynamic effects were measured with VerifyNow, light transmittance aggregometry (LTA), and thromboelastography (TEG®). The primary endpoint was P2Y12 Reaction Units (PRU) measured by VerifyNow. PRUs during treatment with HCP0911 were not inferior to those during separate treatment (202 ± 52 vs. 207 ± 60 PRU; mean difference, -5 PRU; 90% confidence interval of difference, -23 to 13 PRU; P for non-inferiority = 0.015 for predetermined limit). "BASE" and Aspirin Reaction Units by VerifyNow did not differ between the two treatments. During each treatment, there were no differences in maximal and final platelet aggregations by LTA (all P values ≥0.822) and TEG® measurements. In conclusion, in stented patients, the antiplatelet effect of a fixed-dose clopidogrel-aspirin combination, HCP0911, was not inferior to separate administration of clopidogrel and aspirin.
Collapse
Affiliation(s)
- Jin-Sin Koh
- a Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Republic of Korea
| | - Yongwhi Park
- b Department of Internal Medicine , Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital , Changwon , Republic of Korea
| | - Udaya S Tantry
- c Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute , Fairfax , VA , USA
| | - Jong-Hwa Ahn
- b Department of Internal Medicine , Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital , Changwon , Republic of Korea
| | - Min Gyu Kang
- a Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Republic of Korea
| | - Kyehwan Kim
- a Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Republic of Korea
| | - Jeong Yoon Jang
- b Department of Internal Medicine , Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital , Changwon , Republic of Korea
| | - Hyun Woong Park
- a Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Republic of Korea
| | - Jeong Rang Park
- a Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Republic of Korea
| | - Seok-Jae Hwang
- a Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Republic of Korea
| | - Choong Hwan Kwak
- b Department of Internal Medicine , Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital , Changwon , Republic of Korea
| | - Jin-Yong Hwang
- a Department of Internal Medicine , Gyeongsang National University School of Medicine and Gyeongsang National University Hospital , Jinju , Republic of Korea
| | - Paul A Gurbel
- c Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute , Fairfax , VA , USA
| | - Young-Hoon Jeong
- b Department of Internal Medicine , Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital , Changwon , Republic of Korea.,d Institute of the Health Sciences , Gyeongsang National University , Jinju , Republic of Korea
| |
Collapse
|