Study using digital tools to track medication finds perfect adherence in MS is uncommon

Perfect adherence to oral disease-modifying therapy was uncommon in a study of patients with MS that used digital tools to track medication adherence, according to findings presented at the ACTRIMS virtual meeting.

The researchers noted that nonadherence was “more nuanced than simply missing doses,” which indicated that strategies for increasing adherence to oral disease-modifying therapies is an unmet need in MS care.

“Since 2010, oral disease-modifying therapies (DMTs) have been available to reduce MS disease activity, prevent neurological disability and promote a higher quality of life,” the researchers wrote. “Adherence of [people with MS] to DMTs is overall not well characterized ... but where studies ranged from 46% to 97%. Adherence to oral DMTs (vs., eg, infused DMTs) is particularly under-characterized.”

Dylan R. Rice, of the department of neurology at Massachusetts General Hospital in Boston, and colleagues conducted a randomized, virtual clinical trial of smartphone-based electronic pill bottle adherence monitoring vs. monitoring with mobile health-based medication reminders among people with MS on oral DMTs. The researchers recruited individuals aged over 18 years at Massachusetts General Hospital between January and October 2020.

The study allowed patients to participate virtually or in person for an enrollment visit. Rice and colleagues provided patients with pill bottles with electronic smart caps and randomly assigned them 1:1 to remote smartphone app-based and bottle-based adherence tracking alone or in combination with medication reminders. At baseline, all participants completed health histories, the Montreal Cognitive Assessment and a symbol digit modalities test. The follow-up period was 90 days.

The researchers defined perfect adherence as the number of days in which a participant took the DMT ±1 hour of the scheduled dose and tracked the number of participants who took pills early, on time, late or not at all and compared adherence between arms.

The study included 85 participants (mean age, 45 years [range, 19-73 years]; 78% female; 81% white, 11% Black, 5% Hispanic/Latinx, 2% Asian). Rice and colleagues reported a median Montreal Cognitive Assessment of 27, a median symbol digit modalities test of 54 and a mean MS duration of 11 years (range, 1-44 years). The researchers randomly assigned 42 patients to remote tracking and 43 to tracking plus electronic medication reminders. Most participants (81%) enrolled in the study virtually and all participants remained virtual throughout the course of the study, according to the results from Rice and colleagues.

The results presented at ACTRIMS were based on an average available data length of 85.3 days (range, 14-90 days).

Rice and colleagues found that perfect adherence was significantly higher in the tracking with reminders group (68%) compared with the tracking only group (61.4%; P = .006).

Of all subgroups measured by collected clinical or demographic variables, only age correlated with perfect adherence; older participants tended to be more perfectly adherent than younger participants (P < .001). Perfect adherence in the older half of participants (73.1%) was higher than in younger participants (60.2%; P = .004).

The researchers also observed that the number of on-time and extra pills increased compared with the observation-only arm. While smart pill bottle data collection was found to be feasible, 12% of participants reported issues with Bluetooth and smartphone syncing during the trial period, which resulted in some incomplete data, according to the study results.

Rice and colleagues said the findings demonstrated that “virtual clinical trials for MS are novel but represent a viable option, particularly during COVID-19.”.

“Perfect adherence to oral DMTs is uncommon, and nonadherence is more nuanced than simply missing doses,” the researchers wrote. “Developing strategies to improve adherence to oral DMTs remains necessary in MS care, and future research could consider patient-centered adherence interventions.”