Last week leaders from industry and academia teamed up to discuss drug adherence issues for older people at the annual congress of the German Society of Gerontology and Geriatrics (DGG) in Bonn.
Reduced mobility, forgetfulness, poor belief in the need for the therapy and adverse drug reactions (ADRs) – caused through reactions with the myriad other medications geriatrics often have to take – were all flagged as key reasons for failed compliance.
Manfred Gogol, geriatrician and former president of the German Society of Gerontology and Geriatrics – who spoke at the congress – told us simpler drug regimens could be the solution to many of the issues. He said new formulations, controlled release systems and delivery techs could all help, especially combined therapies which would reduce the number of dosages.
“The biggest challenge is to deal with drugs or devices adapted to functional decline,” he said. “Reduce the number of drugs when possible through combination. Make formulations different so that big tablets can be replaced by a fluid and so on.”
Another congress speaker, Capsugel’s director for pharmaceutical business development Sven Stegemann, told in-PharmaTechnologist.com that capsule dosage is a good solution as it accommodates different formulation approaches and drug delivery systems.
“For example, a drug product dedicated to Parkinson patients can contain different drugs, with different release profiles in sprinkle form,” he said. “Patients with swallowing issues can easily swallow the medication as well as have an immediate release portion and a sustained release portion to secure high plasma peaks in the early morning time.”
He added visual differentiation such as colour combination and imprint could also save confusion; another feature well suited to the capsule.
Respect your elders
Both Gogol and Stegemann urged the industry to focus more on geriatric patient-centricity – taking into consideration the needs of specific populations.
“Dependent on time and circumstances it may be that elderly patients have a greater, a smaller, a zero or a minus therapy effect. This question with a higher vulnerability and instability has to be addressed,” said Gogol. “Furthermore (…) there are a number of biological, psychological and social factors including environment and other ecological points which interferes with a patient or his living space.”
Stegemen told us the drug delivery technologies and formulations that could address the issues are already available on the market, and besieged manufacturers to use them to help compliance.
“Patient-centric drug products will definitively be an important step forward towards better compliance as it will prevent inappropriate modification of dosage forms like crushing tablets or capsules,” he added.
Gogol went on to implore regulators to make research guidelines clearer so clinicians may feel more comfortable working specifically with the elderly.
“Besides costs – depending on the organisation of health care system and reimbursement – geriatric physicians often do not know of research results and guideline recommendations that meet the needs and the situation of elderly patients,” he said.
“But they are right not to treat as recommended because research results and guideline recommendations usually do not address the situation of patients with complete and lots of morbidity – so-called multimorbidity.”