Electronic monitoring can be useful to assess IPF medication nonadherence, timing

Use of electronic monitoring systems helped identify prevalent medication nonadherence in patients with idiopathic pulmonary fibrosis taking pirfenidone, according to data published in ERJ Open Research.

“This is the first study that used electronic monitoring to prospectively measure adherence patterns, their impact on outcome and its predictors in IPF,” Anouk Delameillieure, MS, PhD student in the department of chronic diseases and metabolism in the Laboratory of Respiratory Diseases and Thoracic Surgery and the department of public health and primary care at the Academic Centre for Nursing and Midwifery at KU Leuven in Belgium, and colleagues wrote.

Researchers conducted a prospective study to evaluated medication adherence to pirfenidone among 55 patients with IPF (mean age, 71.1 years; 76.4% men) using electronic monitoring. Electronic monitoring systems provided insights on whether and when patients took their medication day-to-day. Researchers assessed the impact of medication nonadherence on lung function and selected nonadherence predictors based on the Capability, Opportunity, and Motivation Behaviour (COM-B) model, including health literacy, intentions to adherence, adherence barriers, and knowledge on IPF and pirfenidone and self-reported adverse events.

All patients were followed for 2 years after IPF diagnosis. Baseline mean FVC was 88% predicted and mean diffusing capacity of the lung for carbon monoxide was 58.1% predicted.

Researchers reported an association between the proportion of days with dosing adherence of three pirfenidone intakes and FVC percent predicted (P = .03) but not diffusing capacity of the lung. This demonstrated that a high dosing adherence may be required to maintain stable or improving FVC percent predicted values, the researchers wrote.

Overall, 58.2% of participants successfully implemented at least 90% correct dosing days and 30.9% of participants successful implemented 95% correct dosing days. However, medication adherence significantly decreased over time, the researchers reported (P = .01). Dosing intervals that were too short had a negative impact on lung function outcomes in this patient population, according to the findings.

In addition, self-reported medication nonadherence was significantly associated with poorer electronically measured dosing adherence in univariable and multivariable models (P = .02 for both). Knowledge of IPF and pirfenidone treatment was significantly associated with better dosing adherence, the researchers reported (P = .03).

“More research is needed to confirm our findings and to further investigate the prevalence and predictions of nonadherence, as well as its impact on outcomes,” they wrote. “We recommend measuring adherence as part of routine IPF follow-up and to tackle gaps in treatment knowledge.”