Polypill Therapy is the Key to Improving Treatment Adherence in Comorbid Patients with High Cardiovascular Risk: A Systematic Review andMeta-Analysis

INTRODUCTION: The creation of a fixed combination ("polypill") primarily reflects the medical community's efforts to increase patient adherence to treatment, which contributes to both individual and population- level risk reduction. However, different studies use various methods to assess patient adherence. The results of different studies regarding this topic are controversial. Some studies demonstrate positive effects of "polypill" administration on patient adherence, and other studies show no statistically significant differences compared to standard therapy. The aim of this review was to assess the adherence to treatment in comorbid patients with high cardiovascular risk who used "polypill" therapy compared to standard monocomponent therapy. METHODS: The search was conducted in accordance with PRISMA requirements across the databases PubMed, Google Scholar, and ClinicalTrials.gov. Two independent reviewers conducted the search, and in cases of disagreement, a third reviewer was involved. A total of 1.941 publications were analyzed, of which 358 were found in PubMed, 1.580 were found in Google Scholar, and 3 were found in Clinical Trials. A total of 11 publications were selected for the final analysis of full-text articles. The meta-analysis evaluated the adherence to therapy in patients after myocardial infarction, with dyslipidemia, arterial hypertension, and high cardiovascular risk, who used "polypill" therapy, compared to standard therapy with monocomponent drugs. RESULTS: The meta-analysis of adherence to "polypill" therapy compared to standard therapy included 11 studies involving comorbid patients with high cardiovascular risk. The total number of patients was 39.286. 19.664 patients used "polypill" therapy, and 19.622 patients used standard therapy with monocomponent drugs. According to the results of the meta-analysis, high adherence to treatment is more common in patients using "polypill" compared to standard therapy (relative risk (RR) 1.434 (95% CI 1.26-1.64, p<0.001). DISCUSSION: "Polypill" therapy is generally effective in increasing adherence. Attention should also be paid to other factors that can influence patients' adherence to "polypill" therapy, such as the duration of the follow-up period, the number of patient visits, initial adherence, and patient education. The advantages and limitations of "polypill" therapy are described in this review. Despite certain limitations, "polypill" is considered a promising option for improving patients' adherence in clinical practice, especially when combined with other adherence- enhancing strategies. CONCLUSION: A current systematic review and meta-analysis have shown that the use of fixed-dose combinations ("polypill") in comorbid patients with high cardiovascular risk is associated with greater adherence to treatment compared to standard therapy with monocomponent drugs.