One Pill To Rule Them All

Researchers at the Massachusetts Institute of Technology and Boston’s Brigham and Women’s Hospital, in conjunction with Lyndra, a Bill & Melinda Gates Foundation-backed biomedical startup, have developed a way to deliver a week’s worth of medication in a single dose. This advanced technology can potentially revolutionize the way antiretroviral drug regimens are delivered to people living with HIV, drastically improving a patient’s adherence.

The revolutionary delivery system is a small, six-pronged, starfish-shaped “backbone” that is encased in a capsule. Once the capsule dissolves in the stomach, the arms expand out to form the star-shaped configuration — too large to be passed from the stomach into the digestive tract, but still safe enough to remain in the stomach. The backbone of the device is made of a polymer, designed to maintain its integrity for one week before breaking apart and passing safely through the intestines.

Each arm contains a week’s dosage of medicine, each within a different polymer designed to dissolve at a set rate. By matching the drug with the correct rate at which the chosen polymer will dissolve, researchers were able to combine drugs that used different schedules and doses within a single pill. Previous efforts had been unable to solve this problem.

“Because people with HIV require lifelong antiretroviral therapy, a long-acting oral option that could be taken at home would make it easier for patients to adhere to their treatment regimen,” said Andrew Bellinger, cofounder and chief scientific officer at Lyndra, in a press release. “By fitting into a patient’s regular routine, an ultra-long-acting therapy would be taken consistently, improving therapeutic success and helping avoid viral resistance.” The key is the “versatility of a variety of polymer matrices to formulate and deliver controlled release of three highly-potent antiretrovials for a week after a single dose.”

For many HIV-positive people on combination therapies, proper drug adherence can be an issue day by day. As of now, all combination therapy drugs on the market must be taken daily, which can lead to medication fatigue. Missing doses can increase the risk of drug resistance while decreasing the chances of remaining undetectable, whereby your viral load is so low that it becomes near impossible to transmit to an HIV-negative person. Without proper adherence, poz people can also become more susceptible to infections or other health issues.

The importance of adherence — and the potential benefits of this new delivery system — aren’t limited to HIV-positive people. The National Center for Biotechnology Information estimates there are nearly $100 billion in avoidable medical expenses directly resulting from people not taking medications on time, and as prescribed. This new delivery system is designed to not only save money, but to save lives. As Bellinger said in the statement, the goal is to “dramatically improve the probability of treatment success for patients who often forget to take their medicine on time.”

For now, Lyndra plans to limit their areas of focus; one of these areas is a partnership with Allergan to explore its use in Alzheimer’s and other neurological disorders. That could also benefit people living with HIV, as they can be more susceptible to neurological issues as they age.

Moving forward, Lyndra hopes to also examine its potential for use in developing long-acting treatments for cardiovascular disease and diabetes. In much the way once-daily dosages of drugs revolutionized the treatment of HIV-positive people, so too does Lyndra’s new weekly capsule. No longer may it be “an apple a day to keep the doctor away,” but simply a once-weekly pill.