Medication Adherence
Researchers are also turning to technology to monitor patients’ medication adherence, a huge but often overlooked problem, said Bernard Vrijens, PhD, chief executive officer at Advanced Analytical Research on Drug Exposure.
“When we have suboptimal adherence in practice, typically it leads to treatment failure,” Dr. Vrijens said. “When the treatment fails, the disease progresses. Sometimes we have acute events. And when the disease progresses, what we typically do is give more complex treatments. The more complex the treatment, the worse is the adherence. This is an extremely costly loop.”
Many apps push patients to take their medications, Dr. Vrijens noted. But they simply give alerts and aren’t integrated into a patient’s overall health picture. “Outcome is key. It’s not [about] taking the medication, it’s really [about] optimizing outcome, minimizing adverse effects.”
In research he has led, investigators use electronic monitoring to assess patients’ adherence—the act of a patient removing a pill from its container is recorded. The results show how vastly different patients’ adherence can be even if, overall, they have the same adherence rate.
He showed data for six patients, all with an adherence rate of 81%. But one patient tended to be diligent in the morning while faltering at night. Another started out well and then began to deviate from the schedule. Another had such wild adherence that there was no clear pattern. These details—when patients didn’t take a pill or when they took double to make up for it—are important in making treatment decisions, Dr. Vrijens said. Research also suggests showing patients their own mistakes is the best way to improve their behavior.3
Adherence has become more important lately because new therapies tend to feature a narrow therapeutic window—too little delivers little effectiveness, and too much results in toxicity, he said.
“We need to bring knowledge to the point of care” to better individualize treatment, Dr. Vrijens said. “Medication adherence is really a vital sign to measure and manage in this setting of individualization of treatment.”
Thomas R. Collins is a freelance writer living in South Florida.
References
- Bartlett SJ, Orbai AM, Duncan T. Reliability and validity of selected PROMIS measures in people with rheumatoid arthritis. PLoS One. 2015 Sep 17;10(9):e0138543.
- Gossec L, Guyard F, Leroy D, et al. Detection of flares by decrease in physical activity, collected using wearable activity trackers, in rheumatoid arthritis or axial spondyloarthritis: An application of machine-learning analyses in rheumatology. Arthritis Care Res (Hoboken). 2018 Sep 22.
- Demonceau J, Ruppar T, Kristanto P, et al. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: A systematic literature review and meta-analysis. Drugs. 2013 May;73(6):545–562.