Topic of Choice - The future of pharmacy and polypills

This blog was inspired by “The future of drugs” in Ten Drugs: How Plants, Powders, and Pills Have Shaped the History of Medicine by Thomas Hager.

What is a polypill? UK physicians Nicholas Wald and Malcolm Law introduced the term in 2000. They proposed combining multiple medications that prevent cardiovascular disease into one single “polypill.” Within the next year, they obtained a patent for their idea in the EU and Canada. By 2003, The British Medical Journal reported that their idea was one of the most important scientific publications of the last 50 years.


If this concept sounds familiar, it’s because combination medications such as lisinopril-HCTZ and alogliptin-metformin are available in the US. But why aren’t these considered a form of polypill? It seems that key differences are that these medications are used for disease treatment, not prevention, and are only available as tablets. The Polypill website specifically refers to a capsule formulation that is not a licensed medication.


Polypill has developed The Polypill Prevention Programme, an online service exclusively available to residents of the UK. Patients must be 50 years or older with no history of cardiovascular disease to qualify. If approved through an online consultation, they receive a once daily preventative medication containing three different blood pressure medications and a statin. The cost of this service is £98 (~$130) for each 12 week supply or ~$40/month. Polypill partners with the UK chain pharmacy Cohens Chemist to make their product, which includes the following:

  1. HCTZ 12.5 mg

  2. Amlodipine 2.5 mg

  3. Losartan 25 mg

  4. Rosuvastatin 10 mg


Folic acid and aspirin have also been included with these agents in the past.


Let’s talk about the evidence. The Polypill Crossover Trial was a randomized, double-blind, placebo-controlled crossover trial published in 2012. The study aimed to establish Polypill efficacy in reducing cholesterol and blood pressure. 86 subjects received the four agents detailed above with simvastatin 40 mg instead of rosuvastatin 10 mg. The authors state, “The Polypill resulted in the predicted reductions in blood pressure and LDL cholesterol. Long term reductions of this magnitude would have a substantial effect in preventing heart attacks and strokes.” Two of the three authors of this publication are brothers David and Nicholas Wald, who own Polypill. Given this knowledge, the small sample size, and the “substantial” effect concluded from a basic demonstration of the effects of antihypertensive and antihyperlipidemic agents, I can’t say I feel too positively about the study or its conclusions.


Out of curiosity I wanted to start an online consultation, but that instantly connects you to a physician. Instead, I used the Polypill Health Benefits Calculator to see if Baby Yoda would benefit from polypill. Baby Yoda (assuming he is a young 50 years old) has a 34% chance to benefit from taking the polypill as recommended. If the force is with him and he does benefit, he will expect to live without a heart attack or stroke for an extra 8.1 years of life. Of note, the years of life gained and percent of people who benefit decreases substantially with increasing age. 


Resources

What is the Polypill Prevention Programme? - Polypill.com

Randomized Polypill Crossover Trial in People Aged 50 and Over - PMC (nih.gov)

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