Kombinationsterapi

Kombinationsterapi refers to the use of two or more therapeutic modalities, usually medications, in combination to improve outcomes, prevent resistance, or reduce toxicity. It is applied across medical fields, including oncology, infectious diseases, cardiology, and psychiatry. The core idea is that combined treatments can produce greater effect than any single therapy alone, through additive, synergistic, or potentiating interactions.

Rationale and approaches: Combining agents can increase efficacy by targeting multiple pathways, reduce the required dose of each agent, or prevent the emergence of resistance, particularly in infectious diseases and cancer. Combinations can be pharmacological (drug–drug), non-pharmacological (surgery plus radiotherapy), or mixed. They can be given simultaneously or sequentially, and they may aim for additive, synergistic, or less-than-additive effects. In antiretroviral therapy, for example, multiple drugs reduce viral load and resistance risk; in cancer, regimens combine cytotoxic drugs and targeted agents.

Evidence and evaluation: The benefits are established through clinical trials and meta-analyses. Pharmacodynamic and pharmacokinetic considerations, including drug interactions, are important. Tools such as isobolographic analysis and combination index help assess synergy, but real-world results depend on patient factors and adherence.

Risks and challenges: Increased risk of adverse effects, drug–drug interactions, complex dosing, higher costs, and adherence burden. Careful regimen design and monitoring by clinicians are essential.

Examples: HAART for HIV, RIPE therapy for tuberculosis, combination chemotherapy regimens for various cancers, and broad-spectrum antibiotic combinations for severe infections.

See also: combination therapy, polypharmacy, synergy, isobolography, multi-modality therapy.