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

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  • 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

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    Blueberries are a superfood that can help to lower high blood pressure. Reuters
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    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
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    A daily serving of kiwi can reduce blood pressure in people with mildly elevated levels. Getty
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    Watermelon contains an amino acid called citrulline, which may help to manage blood pressure. Getty Images
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    Oats contain a type of fibre called beta-glucan, which may reduce blood cholesterol levels. Getty
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    Leafy green vegetables are rich in nitrates which help to manage blood pressure. Reuters
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    One study reported that garlic extract reduced both systolic and diastolic blood pressure in hypertensive people. Getty
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    Eating probiotics such as kimchi can have a positive effect on high blood pressure. Reuters
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    Scientists looked into the effects of a diet rich in pulses on rats and reported decreased levels of blood pressure. Getty
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    Yoghurt may reduce the risk of high blood pressure in women. Getty
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    One cup of pomegranate juice daily for 28 days can lower high blood pressure in the short term. Reuters
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    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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Disposing of non-recycleable masks
    Use your ‘black bag’ bin at home Do not put them in a recycling bin Take them home with you if there is no litter bin
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PROFILE OF STARZPLAY

Date started: 2014

Founders: Maaz Sheikh, Danny Bates

Based: Dubai, UAE

Sector: Entertainment/Streaming Video On Demand

Number of employees: 125

Investors/Investment amount: $125 million. Major investors include Starz/Lionsgate, State Street, SEQ and Delta Partners

The specs: 2019 Mercedes-Benz C200 Coupe


Price, base: Dh201,153
Engine: 2.0-litre turbocharged four-cylinder
Transmission: Nine-speed automatic
Power: 204hp @ 5,800rpm
Torque: 300Nm @ 1,600rpm
Fuel economy, combined: 6.7L / 100km

Apple product price list

iPad Pro

11" - $799 (64GB)
12.9" - $999 (64GB)

MacBook Air 

$1,199

Mac Mini

$799

8 traditional Jamaican dishes to try at Kingston 21

  1. Trench Town Rock: Jamaican-style curry goat served in a pastry basket with a carrot and potato garnish
  2. Rock Steady Jerk Chicken: chicken marinated for 24 hours and slow-cooked on the grill
  3. Mento Oxtail: flavoured oxtail stewed for five hours with herbs
  4. Ackee and salt fish: the national dish of Jamaica makes for a hearty breakfast
  5. Jamaican porridge: another breakfast favourite, can be made with peanut, cornmeal, banana and plantain
  6. Jamaican beef patty: a pastry with ground beef filling
  7. Hellshire Pon di Beach: Fresh fish with pickles
  8. Out of Many: traditional sweet potato pudding
On Women's Day
How to increase your savings
  • Have a plan for your savings.
  • Decide on your emergency fund target and once that's achieved, assign your savings to another financial goal such as saving for a house or investing for retirement.
  • Decide on a financial goal that is important to you and put your savings to work for you.
  • It's important to have a purpose for your savings as it helps to keep you motivated to continue while also reducing the temptation to spend your savings. 

- Carol Glynn, founder of Conscious Finance Coaching

 

 

The burning issue

The internal combustion engine is facing a watershed moment – major manufacturer Volvo is to stop producing petroleum-powered vehicles by 2021 and countries in Europe, including the UK, have vowed to ban their sale before 2040. The National takes a look at the story of one of the most successful technologies of the last 100 years and how it has impacted life in the UAE. 

Read part four: an affection for classic cars lives on

Read part three: the age of the electric vehicle begins

Read part two: how climate change drove the race for an alternative 

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Who was Alfred Nobel?

The Nobel Prize was created by wealthy Swedish chemist and entrepreneur Alfred Nobel.

  • In his will he dictated that the bulk of his estate should be used to fund "prizes to those who, during the preceding year, have conferred the greatest benefit to humankind".
  • Nobel is best known as the inventor of dynamite, but also wrote poetry and drama and could speak Russian, French, English and German by the age of 17. The five original prize categories reflect the interests closest to his heart.
  • Nobel died in 1896 but it took until 1901, following a legal battle over his will, before the first prizes were awarded.
UAE currency: the story behind the money in your pockets
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Name: Peter Dicce

Title: Assistant dean of students and director of athletics

Favourite sport: soccer

Favourite team: Bayern Munich

Favourite player: Franz Beckenbauer

Favourite activity in Abu Dhabi: scuba diving in the Northern Emirates 

 

How to avoid crypto fraud
  • Use unique usernames and passwords while enabling multi-factor authentication.
  • Use an offline private key, a physical device that requires manual activation, whenever you access your wallet.
  • Avoid suspicious social media ads promoting fraudulent schemes.
  • Only invest in crypto projects that you fully understand.
  • Critically assess whether a project’s promises or returns seem too good to be true.
  • Only use reputable platforms that have a track record of strong regulatory compliance.
  • Store funds in hardware wallets as opposed to online exchanges.
While you're here
Read
On Women's Day
On Women's Day
UAE currency: the story behind the money in your pockets
Overview

Cricket World Cup League Two: Nepal, Oman, United States tri-series, Tribhuvan University, Kathmandu

Fixtures
Wednesday February 5, Oman v Nepal
Thursday, February 6, Oman v United States
Saturday, February 8, United States v Nepal
Sunday, February 9, Oman v Nepal
Tuesday, February 11, Oman v United States
Wednesday, February 12, United States v Nepal

MATCH INFO

Final: England v South Africa, Saturday, 1pm

While you're here
Stage 5 results

1 Tadej Pogacar (SLO) UAE Team Emirates 3:48:53

2 Alexey Lutsenko (KAZ) Astana Pro Team -

3 Adam Yates (GBR) Mitchelton-Scott - 

4 David Gaudu (FRA) Groupama-FDJ  0:00:04

5 Ilnur Zakarin (RUS) CCC Team 0:00:07

General Classification:

1 Adam Yates (GBR) Mitchelton-Scott 20:35:04

2 Tadej Pogacar (SlO) UAE Team Emirates 0:01:01

3 Alexey Lutsenko (KAZ) Astana Pro Team 0:01:33

4 David Gaudu (FRA) Groupama-FDJ 0:01:48

5 Rafał Majka (POL) Bora-Hansgrohe 0:02:11

Match info

Manchester United 1
Fred (18')

Wolves 1
Moutinho (53')

UK’s AI plan
  • AI ambassadors such as MIT economist Simon Johnson, Monzo cofounder Tom Blomfield and Google DeepMind’s Raia Hadsell
  • £10bn AI growth zone in South Wales to create 5,000 jobs
  • £100m of government support for startups building AI hardware products
  • £250m to train new AI models
What is an ETF?

An exchange traded fund is a type of investment fund that can be traded quickly and easily, just like stocks and shares. They come with no upfront costs aside from your brokerage's dealing charges and annual fees, which are far lower than on traditional mutual investment funds. Charges are as low as 0.03 per cent on one of the very cheapest (and most popular), Vanguard S&P 500 ETF, with the maximum around 0.75 per cent.

There is no fund manager deciding which stocks and other assets to invest in, instead they passively track their chosen index, country, region or commodity, regardless of whether it goes up or down.

The first ETF was launched as recently as 1993, but the sector boasted $5.78 billion in assets under management at the end of September as inflows hit record highs, according to the latest figures from ETFGI, a leading independent research and consultancy firm.

There are thousands to choose from, with the five largest providers BlackRock’s iShares, Vanguard, State Street Global Advisers, Deutsche Bank X-trackers and Invesco PowerShares.

While the best-known track major indices such as MSCI World, the S&P 500 and FTSE 100, you can also invest in specific countries or regions, large, medium or small companies, government bonds, gold, crude oil, cocoa, water, carbon, cattle, corn futures, currency shifts or even a stock market crash. 

Women’s World T20, Asia Qualifier, in Bangkok

UAE fixtures Mon Nov 20, v China; Tue Nov 21, v Thailand; Thu Nov 23, v Nepal; Fri Nov 24, v Hong Kong; Sun Nov 26, v Malaysia; Mon Nov 27, Final

(The winners will progress to the Global Qualifier)

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Last 10 winners of African Footballer of the Year

2006: Didier Drogba (Chelsea and Ivory Coast)
2007: Frederic Kanoute (Sevilla and Mali)
2008: Emmanuel Adebayor (Arsenal and Togo)
2009: Didier Drogba (Chelsea and Ivory Coast)
2010: Samuel Eto’o (Inter Milan and Cameroon)
2011: Yaya Toure (Manchester City and Ivory Coast)
2012: Yaya Toure (Manchester City and Ivory Coast)
2013: Yaya Toure (Manchester City and Ivory Coast)
2014: Yaya Toure (Manchester City and Ivory Coast)
2015: Pierre-Emerick Aubameyang (Borussia Dortmund and Gabon)
2016: Riyad Mahrez (Leicester City and Algeria)

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While you're here
Winners

Best Men's Player of the Year: Kylian Mbappe (PSG)

Maradona Award for Best Goal Scorer of the Year: Robert Lewandowski (Bayern Munich)

TikTok Fans’ Player of the Year: Robert Lewandowski

Top Goal Scorer of All Time: Cristiano Ronaldo (Manchester United)

Best Women's Player of the Year: Alexia Putellas (Barcelona)

Best Men's Club of the Year: Chelsea

Best Women's Club of the Year: Barcelona

Best Defender of the Year: Leonardo Bonucci (Juventus/Italy)

Best Goalkeeper of the Year: Gianluigi Donnarumma (PSG/Italy)

Best Coach of the Year: Roberto Mancini (Italy)

Best National Team of the Year: Italy 

Best Agent of the Year: Federico Pastorello

Best Sporting Director of the Year: Txiki Begiristain (Manchester City)

Player Career Award: Ronaldinho

The specs: 2018 Renault Koleos

Price, base: From Dh77,900
Engine: 2.5L, in-line four-cylinder
Transmission: Continuously variable transmission
Power: 170hp @ 6,000rpm
Torque: 233Nm @ 4,000rpm
Fuel economy, combined: 8.3L / 100km

Updated: August 03, 2023, 10:31 AM