Kombinationsregimer

Kombinationsregimer are treatment approaches that use more than one therapeutic agent or modality at the same time to treat a disease. The goal is to improve efficacy, broaden the therapeutic effect, reduce the emergence of resistance, and address heterogeneity within a disease such as cancer or infectious diseases. They are used across fields including infectious diseases, oncology, and pharmacology.

Key principles of design include pursuing synergistic effects between agents, minimizing overlapping toxicities, and ensuring pharmacokinetic and pharmacodynamic compatibility. Regimens are often structured to balance efficacy with tolerability, using dose adjustments and treatment sequencing to manage adverse effects and interactions. Adherence and monitoring are central, as complex regimens increase the risk of noncompliance and drug interactions.

Common examples

- HIV: Combination antiretroviral therapy (cART) typically combines at least three antiretrovirals from two or more drug classes (for example, two nucleoside reverse transcriptase inhibitors plus a third agent such as an integrase inhibitor or protease inhibitor) to achieve durable suppression of viral load.

- Tuberculosis: Standard initial therapy commonly uses a four-drug regimen (RIPE: rifampicin, isoniazid, pyrazinamide, ethambutol) to prevent resistance and shorten treatment duration.

- Oncology: Multidrug regimens like CHOP or FOLFOX combine cytotoxic drugs to improve tumor kill rates; regimens may include targeted therapies or immunotherapies, sometimes with radiotherapy.

- Antibiotics: In certain severe infections, combinations may be used to broaden activity or prevent resistance, though they require careful stewardship.

Challenges and considerations include drug–drug interactions, cumulative toxicity, cost, adherence, and the need for individualized regimens based on patient factors, resistance patterns, and the tumor or pathogen biology.