Zilebesiran only has to be administered once every six months as an injection, in contrast to most blood pressure medications, which should be taken every day as tablets. Getty Images
Zilebesiran only has to be administered once every six months as an injection, in contrast to most blood pressure medications, which should be taken every day as tablets. Getty Images
Zilebesiran only has to be administered once every six months as an injection, in contrast to most blood pressure medications, which should be taken every day as tablets. Getty Images
Zilebesiran only has to be administered once every six months as an injection, in contrast to most blood pressure medications, which should be taken every day as tablets. Getty Images

Health

Could long-term injections replace daily pills that treat chronic illnesses?

A new medication, given twice a year, could reduce the number of patients taking daily tablets

Daniel Bardsley
Daniel Bardsley

August 03, 2023

  • English
  • Arabic

For all the money and effort that goes into developing drugs, they can be rendered ineffective if they are not taken properly.

Rates of non-adherence, which may involve skipping doses or taking them at the wrong time, can be around 50 per cent among patients prescribed medication for chronic illnesses.

It is a key reason why drugs underperform in the real world compared to when they are tested in carefully controlled trials, where adherence tends to be higher.

Aside from the wasted spending on medication, the effects of non-adherence are significant. A study published in May in Nature Reviews Drug Discovery reported that it results in the deaths of about 125,000 patients in the US alone each year.

“Poor adherence is also estimated to cause 10 per cent of all hospitalisations and underlies $100–300 billion of avoidable healthcare costs annually,” the study said.

This is why recent trial results indicating that a drug called Zilebesiran, effective at treating blood pressure, have sparked interest.

Zilebesiran only has to be administered once every six months as an injection, in contrast to most blood pressure medications, which should be taken daily as tablets.

“There’s a lot of evidence that if we have a drug-delivery regime which works and is given once and lasts for three months, six months or whatever, it’s much, much better because, one, there’s regularity in that dose and two, the dose is maintained at the correct level,” said Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter Medical School in the UK.

“So long-term medications are a great advance in the scientific technology whereby it’s a case of take and forget.”

Drug holidays

Failing to take tablets properly can be a particular problem for conditions, such as high blood pressure, where patients typically do not have symptoms.

“If you are a chronic patient, the tendency is as you become asymptomatic if the treatment works, you think, ‘I’m feeling well, why should I take the drug?’ This is a very known effect with, for example, hypertension,” said Professor Oscar Della Pasqua, professor of clinical pharmacology and therapeutics at University College London.

“Hypertensive patients don’t have symptoms and you think ‘I will stop taking the drug,’ or you stop taking the drug as you should, or you have dose gaps – you don’t have your new prescription, you don’t go to the pharmacy – we call drug holidays.

“Altogether, this variable adherence pattern can lead to potential complications, recurrence of a condition and so on.”

Super food to lower blood pressure - in pictures

Blueberries are a superfood that can help to lower high blood pressure. Reuters
Blueberries are a superfood that can help to lower high blood pressure. Reuters
Research suggests that beetroot’s high levels of inorganic nitrate cause a reduction in blood pressure. Getty
Research suggests that beetroot’s high levels of inorganic nitrate cause a reduction in blood pressure. Getty
Scientific trials found that dark chocolate with a cocoa content of between 50 per cent and 70 per cent is a treat that could help lower blood pressure. Getty
Scientific trials found that dark chocolate with a cocoa content of between 50 per cent and 70 per cent is a treat that could help lower blood pressure. Getty
A daily serving of kiwi can reduce blood pressure in people with mildly elevated levels. Getty
A daily serving of kiwi can reduce blood pressure in people with mildly elevated levels. Getty
Watermelon contains an amino acid called citrulline, which may help to manage blood pressure. Getty Images
Watermelon contains an amino acid called citrulline, which may help to manage blood pressure. Getty Images
Oats contain a type of fibre called beta-glucan, which may reduce blood cholesterol levels. Getty
Oats contain a type of fibre called beta-glucan, which may reduce blood cholesterol levels. Getty
Leafy green vegetables are rich in nitrates which help to manage blood pressure. Reuters
Leafy green vegetables are rich in nitrates which help to manage blood pressure. Reuters
One study reported that garlic extract reduced both systolic and diastolic blood pressure in hypertensive people. Getty
One study reported that garlic extract reduced both systolic and diastolic blood pressure in hypertensive people. Getty
Eating probiotics such as kimchi can have a positive effect on high blood pressure. Reuters
Eating probiotics such as kimchi can have a positive effect on high blood pressure. Reuters
Scientists looked into the effects of a diet rich in pulses on rats and reported decreased levels of blood pressure. Getty
Scientists looked into the effects of a diet rich in pulses on rats and reported decreased levels of blood pressure. Getty
Yoghurt may reduce the risk of high blood pressure in women. Getty
Yoghurt may reduce the risk of high blood pressure in women. Getty
One cup of pomegranate juice daily for 28 days can lower high blood pressure in the short term. Reuters
One cup of pomegranate juice daily for 28 days can lower high blood pressure in the short term. Reuters
Cinnamon may also help to reduce blood pressure. Reuters
Cinnamon may also help to reduce blood pressure. Reuters
Pistachios are healthy nuts that may decrease hypertension. Reuters
Pistachios are healthy nuts that may decrease hypertension. Reuters

“With hypertension, the complications can include an increased risk of stroke, a potentially disastrous outcome for the patient and something that results in increased costs for the healthcare provider,” Prof Della Pasqua said.

Patients stop taking medicine

There are varied reasons why patients do not take their drugs as they are meant to.

A 2011 review paper in Mayo Clinic Proceedings noted that some causes relate to the patient, such as a lack of understanding about the medication or a lack of involvement in decision-making about treatment.

Unpleasant side effects may also cause patients to stop taking their medication.

Other reasons are linked to doctors, who may prescribe a complex treatment regimen or not explain adverse effects properly. Dealing with multiple doctors may also lower adherence.

“Believing that medication non-adherence is the 'fault' of the patient is an uninformed and destructive model that is best abandoned,” the study authors wrote.

Dr Bharat Pankhania, a senior consultant on communicable disease control in the UK. Courtesy: Dr Pankhania
Dr Bharat Pankhania, a senior consultant on communicable disease control in the UK. Courtesy: Dr Pankhania

Certain patients have conditions that may make them less likely to take their medication. Among those likely to not follow a course are those with Alzheimer’s disease, where rates of non-compliance have been estimated to be between 17 per cent and 100 per cent. Those with psychosis are also less likely to follow a course of medication.

“A lot of people with psychosis have erratic lifestyles or erratic behaviours. It’s not that they’re bad people, it’s the way their illness is,” Dr Pankhania said.

Longer-lasting

The answer, in some cases, is a medication given as a depot injection, which involves administering a liquid that releases the drug slowly. With antipsychotic medications, the patient may receive an injection once every several weeks or even less often.

Depot injections may be given for a wide variety of other purposes, such as birth control, in which case they may last around three months, and to combat prostate cancer, which lasts as long as six months.

As well as improving adherence, drugs administered less often by injection or IV infusion offer an opportunity for a healthcare professional to see the patient.

“That’s where you combine intervention with a follow-up of the patient’s condition,” Prof Della Pasqua said.

“That aligns the visit with the GP or the nurse, so you have a very regular interaction with your healthcare professional.”

Just as providing longer-lasting medication reduces the number of times people have to take a drug, combining vaccines can also cut the number of injections required.

This is often done with vaccines for children, such as the measles, mumps and rubella vaccine. In some instances, a single injection may offer protection against as many as six diseases.

However, there may be downsides associated with medications that are given less frequently.

If an injection lasts for months, it becomes harder to adjust the dosage. With a hypertension drug, there could be the risk that patients experience episodes of low blood pressure.

Better adherence is often seen as a benefit of medications that need to be taken only infrequently, but Dr Andrew Freedman, a reader in infectious diseases at Cardiff University in the UK, highlighted a pitfall.

“If someone is not very good at taking their drugs if you miss a once-every-six-month dose, you are not getting it at all,” Dr Freedman said.

“If you miss the odd daily dose of a blood pressure medication, it’s going to be less problematic.”

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Company Fact Box

Company name/date started: Abwaab Technologies / September 2019

Founders: Hamdi Tabbaa, co-founder and CEO. Hussein Alsarabi, co-founder and CTO

Based: Amman, Jordan

Sector: Education Technology

Size (employees/revenue): Total team size: 65. Full-time employees: 25. Revenue undisclosed

Stage: early-stage startup 

Investors: Adam Tech Ventures, Endure Capital, Equitrust, the World Bank-backed Innovative Startups SMEs Fund, a London investment fund, a number of former and current executives from Uber and Netflix, among others.

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Event info: The tournament in Kuwait is the first phase of the qualifying process for sides from Asia for the 2020 World T20 in Australia. The UAE must finish within the top three teams out of the six at the competition to advance to the Asia regional finals. Success at regional finals would mean progression to the World T20 Qualifier.

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TECH%20SPECS%3A%20APPLE%20WATCH%20SERIES%209
%3Cp%3E%3Cstrong%3EDisplay%3A%3C%2Fstrong%3E%2041mm%20%E2%80%93%20352%20x%20430%3B%2045mm%20%E2%80%93%20396%20x%20484%3B%20always-on%20Retina%20LTPO%20OLED%2C%202000%20nits%20max%3B%20Ion-X%20glass%20(aluminium%20cases)%2C%20sapphire%20crystal%20(stainless%20steel%20cases)%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EProcessor%3A%3C%2Fstrong%3E%20Apple%20S9%2064-bit%2C%20W3%20wireless%2C%202nd-gen%20Ultra%20Wideband%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3ECapacity%3A%3C%2Fstrong%3E%2064GB%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EMemory%3A%3C%2Fstrong%3E%201GB%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EPlatform%3A%3C%2Fstrong%3E%20watchOS%2010%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EHealth%20metrics%3A%3C%2Fstrong%3E%20Blood%20oxygen%20sensor%2C%20electrical%20heart%20sensor%20and%20ECG%2C%203rd-gen%20optical%20heart%20sensor%2C%20high%20and%20low%20heart%20rate%20notifications%2C%20irregular%20rhythm%20notifications%2C%20sleep%20stages%2C%20temperature%20sensing%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EEmergency%20services%3A%3C%2Fstrong%3E%20Emergency%20SOS%2C%20international%20emergency%20calling%2C%20crash%20detection%2C%20fall%20detection%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EConnectivity%3A%3C%2Fstrong%3E%20GPS%2FGPS%20%2B%20cellular%3B%20Wi-Fi%2C%20LTE%2C%20Bluetooth%205.3%2C%20NFC%20(Apple%20Pay)%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EDurability%3A%3C%2Fstrong%3E%20IP6X%2C%20water%20resistant%20up%20to%2050m%2C%20dust%20resistant%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EBattery%3A%3C%2Fstrong%3E%20308mAh%20Li-ion%2C%20up%20to%2018h%20regular%2F36h%20low%20power%3B%20wireless%20charging%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3ECards%3A%3C%2Fstrong%3E%20eSIM%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EFinishes%3A%3C%2Fstrong%3E%20Aluminium%20%E2%80%93%20midnight%2C%20pink%2C%20Product%20Red%2C%20silver%2C%20starlight%3B%20stainless%20steel%20%E2%80%93%20gold%2C%20graphite%2C%20silver%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EIn%20the%20box%3A%3C%2Fstrong%3E%20Watch%20Series%209%2C%20woven%20magnetic-to-USB-C%20charging%20cable%2C%20band%2Floop%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EPrice%3A%3C%2Fstrong%3E%20Starts%20at%20Dh1%2C599%20(41mm)%20%2F%20Dh1%2C719%20(45mm)%3C%2Fp%3E%0A
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A list of the animal rescue organisations in the UAE

Looking for a new family pet? Here are the links to visit when it comes to adopting... 

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KittySnip

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Amanda's Animal Rescue UAE

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Biography

Her family: She has four sons, aged 29, 27, 25 and 24 and is a grandmother-of-nine

Favourite book: Flashes of Thought by Sheikh Mohammed bin Rashid

Favourite drink: Water

Her hobbies: Reading and volunteer work

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Her motto: I don't wait, I initiate

 

 

 

 

 

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England 290 & 346
Sri Lanka 336 & 226-7 (target 301)

Sri Lanka require another 75 runs with three wickets remaining

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Second Test, at Kandy
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Third Test, at Colombo
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Engine: 2.0-litre turbocharged in-line four-cylinder engine

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Power: 237hp @ 5,000rpm

Torque: 350Nm @ 1,500rpm

Fuel economy, combined: 8.7L / 100km

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Monday, January 28
Iran v Japan, Hazza bin Zayed Stadium (6pm)

Tuesday, January 29
UAEv Qatar, Mohamed Bin Zayed Stadium (6pm)

Friday, February 1
Final, Zayed Sports City Stadium (6pm)

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What Super Bowl LIII

Who is playing New England Patriots v Los Angeles Rams

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Scotland v Ireland:

Scotland (15-1): Stuart Hogg; Tommy Seymour, Huw Jones, Sam Johnson, Sean Maitland; Finn Russell, Greig Laidlaw (capt); Josh Strauss, James Ritchie, Ryan Wilson; Jonny Gray, Grant Gilchrist; Simon Berghan, Stuart McInally, Allan Dell

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Coach: Gregor Townsend (SCO)

Ireland (15-1): Rob Kearney; Keith Earls, Chris Farrell, Bundee Aki, Jacob Stockdale; Jonathan Sexton, Conor Murray; Jack Conan, Sean O'Brien, Peter O'Mahony; James Ryan, Quinn Roux; Tadhg Furlong, Rory Best (capt), Cian Healy

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Manchester United 0

Manchester City 2

Bernardo Silva 54', Sane 66'

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Armies of Sand

By Kenneth Pollack (Oxford University Press)
 

The lowdown

Rating: 4/5

Biog

Mr Kandhari is legally authorised to conduct marriages in the gurdwara

He has officiated weddings of Sikhs and people of different faiths from Malaysia, Sri Lanka, Russia, the US and Canada

Father of two sons, grandfather of six

Plays golf once a week

Enjoys trying new holiday destinations with his wife and family

Walks for an hour every morning

Completed a Bachelor of Commerce degree in Loyola College, Chennai, India

2019 is a milestone because he completes 50 years in business

 

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2017 The Square, Ruben Ostlund

2016 I, Daniel Blake, Ken Loach

2015 Dheepan, Jacques Audiard

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2013 Blue is the Warmest Colour (La Vie d'Adèle: Chapitres 1 et 2), Abdellatif Kechiche, Adele Exarchopoulos and Lea Seydoux

2012 Amour, Michael Haneke

2011 The Tree of Life, Terrence Malick

2010 Uncle Boonmee Who Can Recall His Past Lives (Lung Bunmi Raluek Chat), Apichatpong Weerasethakul

2009 The White Ribbon (Eine deutsche Kindergeschichte), Michael Haneke

2008 The Class (Entre les murs), Laurent Cantet

Huroob Ezterari

Director: Ahmed Moussa

Starring: Ahmed El Sakka, Amir Karara, Ghada Adel and Moustafa Mohammed

Three stars

A Dog's Journey 

Directed by: Gail Mancuso

Starring: Dennis Quaid, Josh Gad, Marg Helgenberger, Betty Gilpin, Kathryn Prescott

3 out of 5 stars

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Updated: August 03, 2023, 10:31 AM`