A Secondary Analysis of the TRIUMPH Trial
There is a recent increase in fixed-dose combination (FDCs) treatment for the initial or early management of hypertensive patients. The association of FDCs in addressing therapeutic inertia along with prescribing patterns is not well researched in past. Wang and colleagues conducted an investigation under the study title “Association of Low-Dose Triple Combination Therapy with Therapeutic Inertia and Prescribing Patterns in Patients with Hypertension A Secondary Analysis of the TRIUMPH Trial” published in JAMA cardiology. Summary of the research is given below:
Objective:
To find the association of antihypertensive triple-drug FDC therapy with therapeutic inertia and prescribing patterns compared with usual care management.
Method:
The investigation includes 700 participants for conducting post hoc analysis of the Triple Pill vs Usual Care Management for Patients with Mild-to-Moderate Hypertension (TRIUMPH) study. Intervention includes usual care or FDC antihypertensive pill namely amlodipine, 2.5 mg; telmisartan, 20 mg; and chlorthalidone, 12.5 mg once per day. With the use of BP-lowering drug class and treatment regimen potency, prescribing patterns were characterized. Binomial logistic regression helped in assessing predictors of therapeutic inertia.
Findings:
Investigation suggests that there is a greater rate of therapeutic inertia with triple pill FDC therapy than usual care. On the other hand, triple pill FDC therapy is associated with improved BP control in presence of fewer unique treatment and clinical pathways. This indicates therapy’s ability in simplifying treatment. The inability to intensify treatment is strongly related to the inability in reaching BP targets at the end of the day. FDCs can be a beneficial therapy for low socioeconomic populations as they provide early and effective treatment with a reduced number of physician visits. However, the study suggests the chances of FDC therapies benefits to reach a threshold when therapeutic inertia persists after initiation of combination therapy.
Limitations:
The study protocol included 4 patient visits only which might have limited the assessment opportunity of treatment intensification and also didn’t fully considered the real-world treatment of hypertension. The study reports to lack in investigating prescriber-related reasons for therapeutic inertia that may vary in the setting of triple pill use. The authors acknowledge the need for more dosage options for the use of the FDC triple pill. This will open up greater opportunities for physicians to intensify therapy without fear of overtreatment and adverse drug effects.