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CTSU Clinical Trial Service Unit & Epidemiological Studies Unit Clinical Trial Service Unit & Epidemiological Studies Unit CTSU University of Oxford Nuffield Department of Clinical Medicine 30 November 2012 CTSU, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK Tel: +44-(0)-1865-743743 Fax: +44-(0)-1865-743985 Website: www.ctsu.ox.ac.uk Dear WHO Expert Committee: I am writing to support the inclusion of fixed dose combination therapy (also known as “polypill” therapy) for secondary prevention of cardiovascular disease in the World Health Organization’s (WHO) Model List of Essential Medicines. I have over the past 30 years been a co-principal investigator in many large-scale trials and meta-analyses of drugs that reduce recurrence rates after occlusive stroke or a myocardial infarct. All these drugs are now off-patent, and together they offer substantial benefits to those who have already suffered such an event, but they are not widely enough used in low and middle-income countries, partly because affordable co-formulations are not conveniently and affordably available To achieve maximum effect, treatments to reduce the global burden of cardiovascular disease must be strategically deployed to reach a diverse population. The availability and use of fixed dose combination therapy for secondary prevention of cardiovascular disease will overcome many of the barriers that currently prevent sufficient treatment, including poor adherence, unaffordable cost and inadequate prescription of medication. Different expert panels, including the WHO and the Combination Pharmacotherapy and Public Health Research Working Group, have recognized the potential value of fixed dose combination therapy for secondary prevention of cardiovascular disease. I agree with and support the recommendation to add fixed dose combination therapy to the WHO Model List of Essential Medicines for secondary prevention of cardiovascular disease based on its relative affordability, availability, and effectiveness. Please feel free to contact me with any questions. Yours sincerely, Sir Richard Peto, FRS Professor of Medical Statistics and Epidemiology Co-directors: Sir Rory Collins FMed Sci FRCP BHF Professor of Medicine and Epidemiology Sir Richard Peto FRS Hon FRCP Professor of Medical Statistics and Epidemiology Jane Armitage FFPH FRCP Colin Baigent FFPH FRCP Jillian Boreham PhD John Cairns FRS Zhengming Chen MBBS DPhil Michael Clarke DPhil Robert Clarke FFPH FRCP Professor of Clinical Trials & Epidemiology Professor of Epidemiology Senior Research Fellow Emeritus Professor of Cancer Professor of Epidemiology Professor of Clinical Epidemiology Reader in Epidemiology Sarah C Darby PhD Christina Davies BMBCh MSc Richard Gray MA MSc Alison Halliday FRCS Michael Hill DPhil Martin Landray PhD FRCP Michael Lay DPhil Professor of Medical Statistics Senior Research Fellow Professor of Medical Statistics Professor of Vascular Surgery Laboratory Scientific Director Reader in Epidemiology Head of Project Information Science Christine Marsden PhD Sarah Parish DPhil Max Parkin MD Susan Richards DPhil David Simpson OBE Hon MFPH Alan Young DPhil Unit Administrator Senior Research Fellow Honorary Senior Research Fellow Senior Research Fellow Director, IATH Director of Information Science .
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