How do medicines prolong survival?

From the Guidelines

Medicines can significantly prolong survival, particularly in patients with chronic conditions such as heart failure, through the use of evidence-based treatments.

Key Medications

• Beta-adrenergic blockers (e.g., carvedilol, metoprolol succinate, and bisoprolol) have been shown to prolong life by at least 20% reduction in the risk of death 1.
• Neprilysin inhibitors (e.g., sacubitril/valsartan) and mineralocorticoid receptor antagonists also demonstrate a significant reduction in mortality risk, with at least a 20% reduction in the risk of death 1.
• Inhibitors of the renin–angiotensin system, such as ACE inhibitors and angiotensin receptor blockers, provide a more modest benefit, with a 5-16% reduction in the risk of death 1.

Treatment Strategies

The use of a forced-titration strategy to achieve and maintain target doses of these medications has been shown to be effective in clinical trials, but is not commonly followed in clinical practice 1. Instead, patients often receive subtarget doses, which may have some benefits but have not been established to prolong life 1.

Clinical Practice

In real-life clinical practice, it is essential to prioritize the use of evidence-based treatments and strive to achieve target doses to maximize the potential for prolonged survival. This may involve careful monitoring and adjustment of medications to minimize adverse events and ensure that patients receive the full benefit of these life-prolonging therapies 1.

From the FDA Drug Label

In a large (1,395 patients randomized), double-blind, placebo-controlled clinical study, metoprolol was shown to reduce 3-month mortality by 36% in patients with suspected or definite myocardial infarction

• Reduction in mortality: Metoprolol has been shown to reduce 3-month mortality by 36% in patients with suspected or definite myocardial infarction.
• Mechanism of survival prolongation: The exact mechanism is not explicitly stated, but it is related to the overall metoprolol regimen, including both early intravenous and later oral treatment. Medicines like metoprolol can prolong survival by reducing mortality in patients with myocardial infarction, as demonstrated by a significant reduction in 3-month mortality 2.

From the Research

Medicines and Survival

Medicines play a crucial role in prolonging survival by effectively managing and treating various diseases. The following points highlight the impact of medicines on survival:

• Medicines have contributed significantly to the increase in life expectancy, with pharmaceuticals accounting for 35% of the improvement in life expectancy between 1990 and 2015 3.
• The use of medicines has led to a decrease in mortality rates for certain diseases, such as ischemic heart disease, which was the largest positive contributor to life expectancy 3.
• Medicines have also improved the quality of life for individuals with chronic conditions, enabling them to live longer and healthier lives 4, 5.
• The development of new medicines and treatments has been instrumental in reducing the burden of diseases, such as HIV/AIDS and diarrheal diseases, which have seen significant decreases in age-standardised DALY rates between 2010 and 2021 5.

Disease-Specific Impact

The impact of medicines on survival varies across different diseases. For example:

• Ischemic heart disease has seen significant improvements in treatment outcomes, making it the largest positive contributor to life expectancy 3.
• Medicines have also been effective in managing and treating diseases such as stroke, neonatal disorders, and chronic obstructive pulmonary disease (COPD) 5, 6.
• However, some diseases, such as anxiety disorders, depressive disorders, and diabetes, have seen increases in age-standardised DALY rates between 2010 and 2021, highlighting the need for continued research and development of effective treatments 5.

Global Health Trends

Global health trends indicate that medicines will continue to play a crucial role in prolonging survival and improving quality of life. Key trends include:

• The global burden of non-communicable diseases is increasing, with medicines being a critical component of treatment and management 5, 6.
• The COVID-19 pandemic has highlighted the importance of pandemic preparedness and the need for effective medicines and treatments to address emerging health threats 5.
• Continued investment in research and development of new medicines and treatments is essential to address the evolving health needs of populations worldwide 4, 3, 5.