Adherence to medication, even placebo, improves outcomes

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The Pharmaceutical Journal
Vol 275 No 7379 p714
10 December 2005

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Adherence to medication, even placebo, improves outcomes

Patients with chronic heart failure who adhere to their medication, even if it is a placebo, have a lower risk of death than patients with poor adherence, an analysis of the CHARM trial has revealed (published online on 7 December at www.thelancet.com).

CHARM trial

The CHARM (candesartan in heart failure: assessment of reduction in mortality and morbidity) programme compared the effects of the angiotensin receptor blocker candesartan with placebo in 7,599 patients with chronic heart failure. Median follow up was for 38 months.

Overall, 89 per cent of patients were at least 80 per cent adherent to their medication. Poor adherers were more likely to be women and smokers and to have higher average heart rates and more comorbid conditions than good adherers.

Researchers examined patients’ levels of adherence in the trial (see Panel) and found good adherence was associated with lower all-cause mortality in all patients (hazard ratio 0.65; 95 per cent confidence interval 0.57–0.75, P<0.0001).

The risk of death was similar for patients in the active treatment (0.66; 0.55–0.81, P<0.0001) and placebo (0.64; 0.53–0.78, P<0.0001) groups.

The researchers say that the finding suggests that adherence is a marker for healthier behaviours that result in better self-management (for example, adherence to effective treatments other than the study medication).

The author of an accompanying comment (ibid) calculates that in the CHARM trial a high level of adherence to placebo had a 3.5 times greater effect on reducing mortality than the overall effect of the study drug.