Global Perspectives: Original Research An Analysis of the Fixed-Dose Combinations Authorized by the European Union, 2009-2014: A Focus on Benefit-Risk and Clinical Development Conditions

Background: Apparent issues with the treatment and management of complex, chronic, and multifactorial diseases with mono-therapies are becoming more prevalent, with a potential solution being fixed-dose combinations (FDCs). There is a certain stigma associated with FDCs, namely after the bans in the mid- to late 20th century; however, FDCs have proven useful in improving efficacy, reducing adverse effects, prolonging marketability, and producing new therapeutic entities. In addition to this, FDCs may be advantageous in increasing patient compliance and reducing off-label use. Methods: FDCs authorized by the European Union in the past 5 years were analyzed according to benefit-risk and clinical trial design. Results: An overall stable authorization of FDCs from 2009 to 2014 was observed, with most being developed to treat cardiac- and immune-related disorders.The aforemen-tioned bans have led to stricter guidelines and regulations on FDCs; however, the examples presented demonstrate that the clinical guidelines from the European Medicines Agency are flexible within limits and may be altered given proper justification. Conclusion:With off-label use, profitability, and reimbursement threatening the development of FDCs, it is the patients who end up suffering the most. The industry, regulatory bodies, and patients need to unite for the successful development of new FDCs