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Rho

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uuid0007aws

Namestring
Rho
Legal namestring
Rho, Inc.
Websiteurl
rhoworld.com
Company typeenum
Private
Founded yearint
1986
Descriptiontext

Rho is a privately held full-service Contract Research Organization (CRO) founded in 1986 and headquartered in Durham, North Carolina, with European headquarters in Riga, Latvia. The company provides Phase I-IV clinical trial execution, biometrics, regulatory strategy and submissions, and quality assurance services to pharmaceutical and biotechnology sponsors as well as US government agencies (NIH, CDC, BARDA) and patient foundations including the Michael J. Fox Foundation, Parkinson's Foundation, and Cystic Fibrosis Foundation.

The company's core technical capabilities center on integrated clinical operations and biometrics, including protocol design (exemplified by the End-in-Mind Trial Design framework), Risk-Based Quality Management, and regulatory submission expertise across 50+ jurisdictions. Its operational footprint spans 12+ countries through wholly-owned subsidiaries such as Dokumeds SIA and multiple RhoWorld entities, enabling transatlantic trial conduct. Rho has contributed to landmark studies including OUtMATCH, which supported the FDA's 2024 approval of Xolair for food allergies.

Rho's business model is professional services-based, with revenue generated through per-project clinical trial engagements typically procured via RFP/RFI processes. Pricing is anchored on study scope, duration, and therapeutic complexity. Customer segments are diversified across enterprise pharma/biotech, US government public-health programs, and foundation-funded academic-style studies, with therapeutic focus areas including neurology (notably Parkinson's disease, supported by 30+ specialists and 90+ studies), respiratory, immunology, and pain. With 501-1,000 employees, Rho positions as a mid-sized full-service alternative between mega-CROs and boutique specialists.

Short descriptiontext

Rho is a privately held full-service Contract Research Organization providing Phase I-IV clinical trial execution, biometrics, regulatory strategy, and quality assurance to pharmaceutical, biotech, and government clients across the US and Europe.

Operating statusenum
Operating
Ownership categoryenum
Headcount rangeband
501–1,000
akta.pro rankint
HeadquartersDurham, United States
HQ citystring
Durham
HQ countrystring
United States
HQ regionstring
North America
Markets served

Serves global market

Offices6 records

Each record includes

City, Country, Type, Description, Source

Keyword5 values
clinical trial services, contract research organization, regulatory submissions, clinical biometrics, pharmacovigilance services
Industry3 codes
1Clinical CROs (Phase I–IV)
CodeHLAGAAAAPrimaryYes
2Specialty Therapeutic-Area CROs (e.g., oncology/rare disease)
CodeHLAGAAALPrimaryNo
3Medical Writing & Regulatory Submission Support CROs
CodeHLAGAAAGPrimaryNo
NAICS code2 codes
  • Scientific Research and Development Services5417
  • Research and Development in the Physical, Engineering, and Life Sciences54171
SIC code1 code
  • Services-Medical Laboratories8071
Product category
Contract Research Services
GTM motion2 records

Each record includes

Type, Description, Source

Revenue model1 record
1Clinical Research Services
TypeProfessional Services
Description

Rho generates revenue through providing full-service clinical trial execution and regulatory support to pharmaceutical, biotech, and government clients. Services include clinical delivery, biometrics, regulatory strategy, and quality assurance. The engagement model is project-based with long-term partnerships typical.

rhoworld.com
Marketing channels5 records

Each record includes

Title, Type, Stage, Description, Source

Distribution channels3 records

Each record includes

Title, Type, Scope, Target buyer, Description, Source

Cost components4 values
Personnel, Operations, Technology or R&D, Marketing or Sales
Pricing details1 tier
1Custom project-based pricing for clinical trial services
ModelOtherBilling cadenceMulti-year contract
Notes

Pricing is determined through RFP/RFI process based on study requirements, therapeutic area complexity, phase of development, number of sites, geographic scope, and specific service needs (clinical delivery, biometrics, regulatory, QA).

rhoworld.com
GTM typeB2B
B2B
Offering typeServices
Services
Core offering1 text field

Rho is a full-service Contract Research Organization (CRO) providing clinical drug development services to pharmaceutical, biotech, and government clients. Core offerings encompass clinical trial execution (project management, monitoring, pharmacovigilance), biometrics (biostatistics, statistical programming, CDISC-compliant data management), regulatory strategy and submissions (IND, NDA, BLA, MAA), and quality assurance across all clinical phases from Phase I through marketing applications.

Differentiator
Functional benefit
Problem solved
Quantifiable outcome1 of 5 values shown
  • Supported over 90 neurology and psychiatry studies across 840+ sites, enrolling over 6,500 participants
+4 more records
Product overview1 text field

Rho is a full-service Contract Research Organization (CRO) offering a comprehensive suite of clinical development services organized around four core pillars: Clinical Delivery (project management, monitoring, pharmacovigilance, and risk-based quality management), Biometrics (biostatistics, statistical programming, and data management), Regulatory Strategy and Submissions, and Quality Assurance. The company operates with an 'End-in-Mind Trial Design' philosophy that aligns trial execution with regulatory approval goals from Phase I through marketing applications (NDA, BLA, MAA). Rho also provides specialized therapeutic expertise across five key areas: Neurology and Psychiatry, Respiratory, Pain Research, Immunology, and Government Partnerships (NIH, CDC, BARDA). The company was founded 40 years ago as a biometrics-focused organization and maintains dual headquarters in Durham, NC and Riga, Latvia.

Product and service1 record
1Clinical Delivery
Scale indicator9 records

Each record includes

Type, Value, Description, Source

Partnership8 partners
Strategic tierCoreTypeStrategic or Co-development Partner
Description

Collaboration with the Michael J. Fox Foundation for Parkinson's Research, working together on Parkinson's disease clinical trials. The foundation leads the Parkinson's community in funding breakthrough research, and Rho provides execution expertise.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

Partnership with the Parkinson's Foundation to advance Parkinson's disease research through clinical trial collaboration, ensuring research is scientifically rigorous and centered on the Parkinson's community.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

Collaboration with the Davis Phinney Foundation on Parkinson's disease research initiatives, working to ensure studies reflect real patient and site needs.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

Collaboration with NIH on federally funded research programs, including the landmark OUtMATCH study evaluating Xolair for multiple food allergies that led to FDA approval.

Strategic tierMajorTypeStrategic or Co-development Partner
Description

Partnership with CDC to advance public health research initiatives and clinical programs supporting national health priorities.

Strategic tierMajorTypeStrategic or Co-development Partner
Description

Collaboration with BARDA to advance public health research and medical countermeasure development.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

Partnership with Cystic Fibrosis Foundation supporting pivotal clinical trials advancing CF therapies worldwide, contributing to groundbreaking research across all phases of development.

Strategic tierCoreTypeStrategic or Co-development Partner
Description

Collaboration on landmark studies including the LEAP (Learning Early About Peanut Allergy) study, which influenced global pediatric guidelines for peanut introduction.

Recent move5 records

Each record includes

Date, Type, Title, Description, Source

Expansion highlight5 records

Each record includes

Type, Description

Peers10 records
TypeBroad incumbent
Description

IQVIA is the largest global CRO and life sciences technology provider, offering full-service clinical development, real-world evidence, and commercial services. Rho competes with IQVIA for full-service Phase I-IV trials but lacks IQVIA's scale, R&D tech platform, and commercial services breadth.

TypeBroad incumbent
Description

ICON is a top-tier global CRO providing clinical research, biometrics, and laboratory services across all therapeutic areas. Post-PRA Health Sciences acquisition, ICON is one of the largest full-service competitors to Rho in Phase I-IV trial execution and regulatory submissions.

TypeDirect peer
Description

Medpace is a mid-to-large CRO with a therapeutically focused, full-service model centered on Phase I-IV trials, biometrics, and regulatory submissions. Medpace's size, profitability, and therapeutic-area focus make it the closest publicly traded comparable to Rho.

TypeBroad incumbent
Description

Labcorp Drug Development is a top-five global CRO providing clinical development, central laboratory, and diagnostics services. It competes with Rho across Phase I-IV clinical trials and central lab-enabled biometrics but operates at substantially larger scale.

TypeDirect peer
Description

Parexel is a mid-tier, PE-owned (EQT/Goldman Sachs) global CRO with therapeutic expertise and full-service clinical development capabilities. Parexel's size, therapeutic focus, and PE-backed structure closely mirror Rho's competitive position.

TypeBroad incumbent
Description

Syneos Health is a large CRO offering Phase I-IV clinical development, biopharmaceutical solutions, and contract sales. Now taken private by Elliott/Veritas, Syneos is a direct competitor in clinical operations and biometrics with greater scale than Rho.

TypeDirect peer
Description

Worldwide Clinical Trials is a mid-tier, therapeutically focused CRO emphasizing CNS, rare disease, cardiometabolic, and oncology trials. Its mid-tier size, therapeutic specialization, and full-service Phase I-IV model closely parallel Rho's profile.

TypeBroad incumbent
Description

Charles River is a large CRO offering preclinical, discovery, and clinical development services. While smaller than Rho in clinical operations, Charles River overlaps on biometrics, biostatistics, and laboratory-enabled clinical services.

TypeBroad incumbent
Description

PPD, acquired by Thermo Fisher in 2021, is a top-five global CRO offering Phase I-IV clinical development, laboratory, and lifecycle management services. PPD competes directly with Rho in full-service trial execution at meaningfully larger scale.

TypeEmerging player
Description

Catalyst is a privately held, therapeutically focused CRO emphasizing oncology and rare disease trials. As a smaller, specialty peer, Catalyst competes with Rho for therapeutic-area-led, mid-sized biotech sponsors rather than large pharma mega-programs.

Market position
Strengths5 records

Each record includes

Headline, Details, Source

Weaknesses5 records

Each record includes

Headline, Details, Source

Competitive moat5 records

Each record includes

Type, Details

Key risks6 records

Each record includes

Headline, Details, Source

Key highlights7 records

Each record includes

Headline, Details, Source

Customer concentration

Classification, Details

Named customers5 records

Each record includes

Name, Industry, Type, Use case, Source, UUID

Segment3 records

Each record includes

Title, Type, Primary, Description, Pain point addressed, Use case, Source

Ideal customer profile3 records

Each record includes

Profile, Firmographic size, Sales motion, Sales cycle length, Buying structure, Purchase trigger, Buyer persona, Geography, Industry vertical, Primary use case, Description, Pain points, Evidence proof points, Target buyer

Technology focused
No
API detail
Has APIbool
No

Docs URL, Description

AI maturity
App detail

Has app

Feature4 records

Each record includes

Title, Differentiator, Description, Source

Core technology
Revenue estimate
Valuation estimate
Number of profiles
Profiles7 records

Each record includes

Name, Designation, Designation category, Overview, Profile commentary, Source

Subsidiaries12 records

Each record includes

Name, Acquired on, Relationship type, Type, Business focus

No data
Funding overview

Funding stage, Last funding date, Total funding USD

Funding rounds1 record

Each record includes

Round, Amount USD, Date, Pre money valuation, Total investors, Investors, News

Investors

Each record includes

Name, Type, Date of entry, Rounds participated, Website

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Each record includes

Name, Acquisition type, Announced date, Completed date, Status, Website, News

Investment

Each record includes

Name, Round, Announced date, Lead investor, Website, News

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Rho

Contract Research Servicesrhoworld.com

Rho is a privately held full-service Contract Research Organization providing Phase I-IV clinical trial execution, biometrics, regulatory strategy, and quality assurance to pharmaceutical, biotech, and government clients across the US and Europe.

What Rho does

Rho is a privately held full-service Contract Research Organization (CRO) founded in 1986 and headquartered in Durham, North Carolina, with European headquarters in Riga, Latvia. The company provides Phase I-IV clinical trial execution, biometrics, regulatory strategy and submissions, and quality assurance services to pharmaceutical and biotechnology sponsors as well as US government agencies (NIH, CDC, BARDA) and patient foundations including the Michael J. Fox Foundation, Parkinson's Foundation, and Cystic Fibrosis Foundation.

The company's core technical capabilities center on integrated clinical operations and biometrics, including protocol design (exemplified by the End-in-Mind Trial Design framework), Risk-Based Quality Management, and regulatory submission expertise across 50+ jurisdictions. Its operational footprint spans 12+ countries through wholly-owned subsidiaries such as Dokumeds SIA and multiple RhoWorld entities, enabling transatlantic trial conduct. Rho has contributed to landmark studies including OUtMATCH, which supported the FDA's 2024 approval of Xolair for food allergies.

Rho's business model is professional services-based, with revenue generated through per-project clinical trial engagements typically procured via RFP/RFI processes. Pricing is anchored on study scope, duration, and therapeutic complexity. Customer segments are diversified across enterprise pharma/biotech, US government public-health programs, and foundation-funded academic-style studies, with therapeutic focus areas including neurology (notably Parkinson's disease, supported by 30+ specialists and 90+ studies), respiratory, immunology, and pain. With 501-1,000 employees, Rho positions as a mid-sized full-service alternative between mega-CROs and boutique specialists.

Rho firmographics

Firmographics
Name
Rho
Legal name
Rho, Inc.
Website
https://rhoworld.com
Company type
Private
Founded year
1986
Operating status
Operating
Headcount range
501–1,000 employees
Short description
Rho is a privately held full-service Contract Research Organization providing Phase I-IV clinical trial execution, biometrics, regulatory strategy, and quality assurance to pharmaceutical, biotech, and government clients across the US and Europe.
Ownership category
akta.pro rank

Rho industry classification

Industry
Product category
Contract Research Services
NAICS
Scientific Research and Development Services (5417), Research and Development in the Physical, Engineering, and Life Sciences (54171)
SIC
Services-Medical Laboratories (8071)
akta.pro primary industry
Clinical CROs (Phase I–IV) (HLAGAAAA)
akta.pro secondary industries
Specialty Therapeutic-Area CROs (e.g., oncology/rare disease) (HLAGAAAL), Medical Writing & Regulatory Submission Support CROs (HLAGAAAG)

Keywords

  • Clinical trial services
  • Contract research organization
  • Regulatory submissions
  • Clinical biometrics
  • Pharmacovigilance services

Where Rho is headquartered

Location

Headquarters

HQ city
Durham
HQ country
United States
HQ region
North America

Offices6 records

Markets served

Rho business model

Business model
GTM type
B2B
Offering type
Services
Cost components
Personnel, Operations, Technology or R&D, Marketing or Sales

Revenue model

  1. Clinical Research Services: Rho generates revenue through providing full-service clinical trial execution and regulatory support to pharmaceutical, biotech, and government clients. Services include clinical delivery, biometrics, regulatory strategy, and quality assurance. The engagement model is project-based with long-term partnerships typical.

Pricing tiers

ModelBillingPrice
OtherMulti-year contractCustom project-based pricing for clinical trial services

Go-to-market motion2 records

Distribution channels3 records

Marketing channels5 records

Rho product offering

Product offering

Core offering

Rho is a full-service Contract Research Organization (CRO) providing clinical drug development services to pharmaceutical, biotech, and government clients. Core offerings encompass clinical trial execution (project management, monitoring, pharmacovigilance), biometrics (biostatistics, statistical programming, CDISC-compliant data management), regulatory strategy and submissions (IND, NDA, BLA, MAA), and quality assurance across all clinical phases from Phase I through marketing applications.

Product overview

Rho is a full-service Contract Research Organization (CRO) offering a comprehensive suite of clinical development services organized around four core pillars: Clinical Delivery (project management, monitoring, pharmacovigilance, and risk-based quality management), Biometrics (biostatistics, statistical programming, and data management), Regulatory Strategy and Submissions, and Quality Assurance. The company operates with an 'End-in-Mind Trial Design' philosophy that aligns trial execution with regulatory approval goals from Phase I through marketing applications (NDA, BLA, MAA). Rho also provides specialized therapeutic expertise across five key areas: Neurology and Psychiatry, Respiratory, Pain Research, Immunology, and Government Partnerships (NIH, CDC, BARDA). The company was founded 40 years ago as a biometrics-focused organization and maintains dual headquarters in Durham, NC and Riga, Latvia.

Differentiator

Problem solved

Functional benefit

Products and services

  • Clinical Delivery

Quantifiable outcome

  • Supported over 90 neurology and psychiatry studies across 840+ sites, enrolling over 6,500 participants
  • +4 more outcomes

Companies that use Rho

Customer profile

Named customers5 records

Segments3 records

Ideal customer profiles3 records

Rho technology and API

Technology

Technology focussed No

API detail

Has API
No
API docs
API detail

Core technology

AI maturity

App detail

Feature4 records

Rho partnerships and signals

Strategic signal

Partnerships

Eight partnerships are on record, tiered core and major.

  • Michael J. Fox FoundationcoreStrategic or Co-development PartnerCollaboration with the Michael J. Fox Foundation for Parkinson's Research, working together on Parkinson's disease clinical trials. The foundation leads the Parkinson's community in funding breakthrough research, and Rho provides execution expertise.
  • Parkinson's FoundationcoreStrategic or Co-development PartnerPartnership with the Parkinson's Foundation to advance Parkinson's disease research through clinical trial collaboration, ensuring research is scientifically rigorous and centered on the Parkinson's community.
  • Davis Phinney FoundationcoreStrategic or Co-development PartnerCollaboration with the Davis Phinney Foundation on Parkinson's disease research initiatives, working to ensure studies reflect real patient and site needs.
  • NIH (National Institutes of Health)coreStrategic or Co-development PartnerCollaboration with NIH on federally funded research programs, including the landmark OUtMATCH study evaluating Xolair for multiple food allergies that led to FDA approval.
  • CDC (Centers for Disease Control and Prevention)majorStrategic or Co-development PartnerPartnership with CDC to advance public health research initiatives and clinical programs supporting national health priorities.
  • BARDA (Biomedical Advanced Research and Development Authority)majorStrategic or Co-development PartnerCollaboration with BARDA to advance public health research and medical countermeasure development.
  • Cystic Fibrosis FoundationcoreStrategic or Co-development PartnerPartnership with Cystic Fibrosis Foundation supporting pivotal clinical trials advancing CF therapies worldwide, contributing to groundbreaking research across all phases of development.
  • Immune Tolerance NetworkcoreStrategic or Co-development PartnerCollaboration on landmark studies including the LEAP (Learning Early About Peanut Allergy) study, which influenced global pediatric guidelines for peanut introduction.

Scale indicators9 records

Recent moves5 records

Expansion highlights5 records

Rho competitors and assessment

Company assessment

Broad incumbents

  • IQVIA: IQVIA is the largest global CRO and life sciences technology provider, offering full-service clinical development, real-world evidence, and commercial services. Rho competes with IQVIA for full-service Phase I-IV trials but lacks IQVIA's scale, R&D tech platform, and commercial services breadth.
  • ICON plc: ICON is a top-tier global CRO providing clinical research, biometrics, and laboratory services across all therapeutic areas. Post-PRA Health Sciences acquisition, ICON is one of the largest full-service competitors to Rho in Phase I-IV trial execution and regulatory submissions.
  • Labcorp Drug Development (formerly Covance): Labcorp Drug Development is a top-five global CRO providing clinical development, central laboratory, and diagnostics services. It competes with Rho across Phase I-IV clinical trials and central lab-enabled biometrics but operates at substantially larger scale.
  • Syneos Health: Syneos Health is a large CRO offering Phase I-IV clinical development, biopharmaceutical solutions, and contract sales. Now taken private by Elliott/Veritas, Syneos is a direct competitor in clinical operations and biometrics with greater scale than Rho.
  • Charles River Laboratories: Charles River is a large CRO offering preclinical, discovery, and clinical development services. While smaller than Rho in clinical operations, Charles River overlaps on biometrics, biostatistics, and laboratory-enabled clinical services.
  • Thermo Fisher Scientific (PPD): PPD, acquired by Thermo Fisher in 2021, is a top-five global CRO offering Phase I-IV clinical development, laboratory, and lifecycle management services. PPD competes directly with Rho in full-service trial execution at meaningfully larger scale.

Direct peers

  • Medpace: Medpace is a mid-to-large CRO with a therapeutically focused, full-service model centered on Phase I-IV trials, biometrics, and regulatory submissions. Medpace's size, profitability, and therapeutic-area focus make it the closest publicly traded comparable to Rho.
  • Parexel International: Parexel is a mid-tier, PE-owned (EQT/Goldman Sachs) global CRO with therapeutic expertise and full-service clinical development capabilities. Parexel's size, therapeutic focus, and PE-backed structure closely mirror Rho's competitive position.
  • Worldwide Clinical Trials: Worldwide Clinical Trials is a mid-tier, therapeutically focused CRO emphasizing CNS, rare disease, cardiometabolic, and oncology trials. Its mid-tier size, therapeutic specialization, and full-service Phase I-IV model closely parallel Rho's profile.

Emerging players

  • Catalyst Clinical Research: Catalyst is a privately held, therapeutically focused CRO emphasizing oncology and rare disease trials. As a smaller, specialty peer, Catalyst competes with Rho for therapeutic-area-led, mid-sized biotech sponsors rather than large pharma mega-programs.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

Rho social profiles

Digital presence

Rho financial estimates

Financial estimate

Revenue estimate

Valuation estimate

Rho leadership team

Management profile

Number of profiles

Profiles7 records

Rho subsidiaries and ownership

Company hierarchy

Subsidiaries12 records

Rho funding detail

Funding detail

Funding overview

Funding rounds1 record

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

Rho M&A and investment

M&A and investment

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Rho

What does Rho do?

Rho is a full-service Contract Research Organization (CRO) providing clinical drug development services to pharmaceutical, biotech, and government clients. Core offerings encompass clinical trial execution (project management, monitoring, pharmacovigilance), biometrics (biostatistics, statistical programming, CDISC-compliant data management), regulatory strategy and submissions (IND, NDA, BLA, MAA), and quality assurance across all clinical phases from Phase I through marketing applications.

Is Rho a public or private company?

Rho is a private company. It is classified as founder individual operated bootstrapped and is currently operating.

When was Rho founded?

Rho was founded in 1986. It employs 501 to 1,000 people.

Where is Rho based?

Rho is headquartered in Durham, United States, in the North America region.

How does Rho make money?

One revenue line is on record: clinical Research Services.

Who are Rho's main competitors?

Broad incumbents on record are IQVIA, ICON plc, Labcorp Drug Development (formerly Covance), Syneos Health, Charles River Laboratories and Thermo Fisher Scientific (PPD). Direct peers are Medpace, Parexel International and Worldwide Clinical Trials. Catalyst Clinical Research is listed as an emerging player.

Does Rho have an API?

No public API is recorded for Rho.

What industry is Rho in?

Rho's product category is Contract Research Services. Its primary akta.pro industry code is HLAGAAAA, Clinical CROs (Phase I–IV), with a secondary code of HLAGAAAL, Specialty Therapeutic-Area CROs (e.g., oncology/rare disease). Its NAICS code is 5417 and its SIC code is 8071.

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Live signals
Rho5 Angel Investors Actively Funding FashionThe article identifies notable angel investors in the fashion sector, including William Ford, Blake Mycoskie, Alfred Lin, and Brian Spaly, who provide capital and industry guidance to startups. It serves as a promotional piece for Rho, a financial management platform designed to help these startups automate finance tasks such as bill pay and accounting.RhonutritionNatural Sources of Glutathione: Your Complete Educational GuideThe article provides an educational overview of glutathione, identifying it as a key antioxidant produced in the body and found in various foods such as cruciferous vegetables, fruits, and protein sources. It details how cooking methods and storage conditions affect glutathione levels and lists specific nutrients like selenium and vitamins C and E that support its production. The text also notes that while dietary intake is discussed, bioavailability remains under investigation, and explicitly promotes Rho's Liposomal Glutathione supplement as a method to elevate bodily levels.GlobeNewswireFirst Wave BioPharma Engages Rho to Manage Phase 2 Clinical Trial of Enhanced Adrulipase FormulationFirst Wave BioPharma announced an agreement with Rho to manage its Phase 2 clinical trial of an enhanced microgranule delivery formulation for adrulipase, targeting exocrine pancreatic insufficiency in cystic fibrosis and chronic pancreatitis. The trial is expected to initiate before the close of 2022, with the formulation designed to reduce pill burden.