will first, what is the polypill? As the name implies, concerned more pills in a single pill.
The idea of \u200b\u200bcombining several pills in one is not new. For cardiovascular disease, for example, pills that combine aspirin and atenolol (a beta-blocker) have existed for decades, known as a bit-'-funghesco of "aspololo. In other clinical areas of fixed-dose combinations of multiple drugs are rife, such as combinations of anti-tuberculosis drugs and anti-retroviral HIV / AIDS.
In 2001, two powerful organizations in the field of public health, the Wellcome Trust UK and the World Health Organisation, have been found to discuss the concept of the polypill. This concept, however, did not really foot until 2003, when Wald and Law in the British Medical Journal published an article which coined the term, which has certainly been more successful than its predecessor "aspololo" (Wald NJ, Law MR, A strategy to reduce cardiovascular disease by More Than 80%, BMJ 2003).
In the same article, Wald and Law proposed the term "polypill" to indicate a combination of five pharmacologically active ingredients (aspirin, a statin to lower your cholesterol, three medications to lower blood pressure, more folic acid) that are in use by decades against cardiovascular disease, with the aim of proposing it to all persons over 55 years of age (we're talking about the West, Europe and USA) regardless of the presence of other risk factors. According to Wald and Law, the widespread use of the polypill, alone, independently of changes in lifestyle or other variables, would reduce the incidence of cardiovascular events by 80%.
What happened to the polypill and its great promise in terms of prevention and a substantial redesign of the policy in the field of public health since 2001?
Not much. Or at least, not much until the last couple of years.
In 2009, in fact, an article in the prestigious medical journal Lancet (you can read the informative article that talks about it, published at BBC News online, here: http://news.bbc.co.uk/2/hi/7971456. stm) showed that a clinical trial in India was safe and well tolerated in a large number of subjects. The trial had Indian arruolato infatti 2,053 individui sani, ma accomunati da un fattore di rischio per malattie cardiovascolari, come alta pressione arteriosa o l'essere fumatori di lunga data, e dimostrava che la combinazione dei cinque principi attivi in una sola pillola ha lo stesso effetto di quello esercitato da ogni singolo principio attivo preso separatamente. Tra gli altri effetti dello studio, a parte questa dimostrazione di "proof of principle" (di principio) e della sicurezza della polipillola, sono state determinate anche una riduzione della pressione arteriosa e della colesterolemia.
Un altro studio, sponsorizzato questa volta dall'Imperial College di Londra, sta attualmente reclutando pazienti (non soggetti sani, a differenza del trial indiano). Lo studio clinical phase III, is called "umpire", acrononimo for "Use of a Multidrug Pill In Reducing Cardiovascular Events", and consists of two "arms" (arms): one to deliver to patients the polypill, the other administering the usual drugs taken by adults to decrease cardiovascular risk. Further study details can be found on the blog run by a lovely Susan Boseley on matters of global health in the Guardian (http://www.guardian.co.uk/society/sarah-boseley-global-health/2010/may/17/ heart-attack-stroke-prevention) or at the same clinical trial: http://clinicaltrials.gov/ct2/show/NCT01057537?term=umpire&rank=1. Other clinical trials are currently active in Australia and New Zealand.
A breve termine quindi sapremo i risultati di questi studi di fase III, che se positivi come le aspettative fanno credere, potrebbero quindi preludere all'immissione della polipillola sul mercato. Alcune voci restano però scettiche, come per esempio quella di Mike Rich, della Associazione per la Pressione Arteriosa Britannica, secondo cui è meglio mangiare sano e fare esercizio fisico (modi dimostrati per diminuire la pressione arteriosa e non solo, visto che conferiscono anche molti altri benefici per la salute) invece che prendere una semplice pillola, come se fosse una panacea a tutti i nostri mali o a errati stili di vita.
E voi, che ne pensate? se fosse disponibile sul mercato, preferireste prendere una polipillola tutte le mattine a breakfast, or get an hour a day of sweating in the gym, paying attention to diet? Or both? and this argument may be valid in the countries in the developing world?
