Drug holidays: an emerging therapy

Patients know how to take holidays from their illnesses. In one study of patients on blood pressure medications, half of them stopped treatment within a year of starting and the other half had at least one drug holiday every year.

Drug holidays can also extend life

It seems you can miss a few doses and still keep that pressure under control.

The beneficial effects of start-stop-restart therapy, though described in Parkinson’s disease last century, are only now emerging in other areas of clinical research. For some patients suffering from Parkinson’s disease, taking a holiday from levodopa therapy, means that they can restart at lower doses and thus reduce or delay the side effects of higher doses. However, the effect is not universal.

Similarly, there is significant controversy around long-term treatment of osteoporosis with bisphosphonates. Studies have shown that the agents accumulate in bones, and effects last for up to 5 years after the bisphosphonates are stopped. That’s potential for an awfully long drug holiday.

Holidaying can also have some positive benefits. For some patients on antidepressant medications, brief breaks improve sexual functioning without causing the depression to return.

Even more promising is the discovery that drug holidays can extend life in patients with some cancers. In lung cancer, taking a break decreases resistance and extends life by several months longer than continuous treatment. Also, in some chronic conditions thought to be incurable, such as rheumatoid arthritis, the holiday may extend to a cure. More than 50% of patients with early disease can discontinue targeted treatment without symptoms recurring nor the disease worsening.

Of course, not all holidays are voluntary. Some are enforced. At any one time, we can be caught out by a lack of supply. When enzyme replacement therapy production was curtailed, many patients with hereditary diseases, like Gaucher disease, had an enforced “holiday” of up to five months. In a follow up study none of the patients developed an irreversible complication.

As drugs become more expensive and manufacturing processes more complex, holidaying is bound to increase. More research is required to understand the long term effects of the medicines we take. Clinicians must become as good at intermittent therapy as they are at starting therapy.

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