The patient as the central figure

Risposta: This is a crucial factor, with a clear impact on patients’ prognosis and quality of life. Indeed, the effectiveness of any treatment does not depend solely on whether it is prescribed appropriately and on the strength of the supporting evidence, but also on the continuity of its application over time. In this sense, adherence is one of the key factors through which the efficacy demonstrated in clinical trials translates into a tangible benefit in clinical practice. This aspect is particularly relevant in the cardiovascular field, where conditions such as high blood pressure and high cholesterol, often progress asymptomatically for long periods, mean that patients do not immediately perceive the benefits of treatment, whilst they may feel the daily burden of it, particularly in cases of polypharmacy, complex treatment regimens or the onset of adverse effects.

For this reason, alongside adherence, treatment persistence is equally crucial – that is, the ability to maintain effective and appropriate treatment over time.

Non-adherence, however, is not solely the patient’s responsibility, as it is a multifactorial phenomenon influenced by the complexity of the treatment regimen, the number and frequency of doses, tolerability, access to care and the quality of the doctor-patient relationship. It follows that therapeutic simplification is in itself a clinical strategy and, where appropriate, the use of fixed-dose combinations – multiple active ingredients in a single formulation – as well as longer dosing intervals can promote continuity and persistence of treatment.

An example of this comes from lipid-lowering therapy using pre-formulated combinations of multiple active ingredients in a single tablet – a statin and ezetimibe – which, by reducing the number of doses, is associated with better treatment adherence. Similarly, PCSK9 inhibitors, administered subcutaneously at longer intervals than daily oral therapy, have shown high levels of treatment adherence and persistence in observational registries. These are examples of how pharmaceutical innovation should not be assessed solely in terms of biological efficacy, but also in terms of its ability to make treatment regimens simpler and more sustainable in the long term.

This must necessarily be accompanied by a strong therapeutic alliance, achieved by discussing treatment objectives with the patient, explaining the expected benefits and periodically reassessing the treatment’s effectiveness and tolerability. In this way, the prescription of treatment is transformed from a unilateral act into a genuinely shared treatment journey.

Adherence, therefore, is not a secondary aspect of treatment but an integral and essential part of it. A treatment strategy can only be considered truly effective when it succeeds in combining scientific evidence, appropriateness, simplicity and long-term sustainability, whilst adapting, as far as possible, to the clinical characteristics and needs of the individual patient.