NeuroVoices: Dylan Rice, on Improving Adherence to MS DMTs

Dylan Rice

At the ACTRIMS Forum 2021, February 25–27, Dylan Rice presented a study he worked on that tested the impact of a smartphone app and electronic pill bottle with audible and visual reminders on the percent of patients with multiple sclerosis (MS) and their adherence to their oral disease-modifying therapies (DMTs). Patients with MS were provided with pill bottles with electronic smart caps from Pillsy and were randomized 1:1 to remote smartphone app- and bottle-based adherence tracking alone versus adherence tracking with medication reminders.

Following the 90-day period, average perfect adherence was statistically significantly higher in the reminders arm (68%) compared to the monitoring only arm (61.4%; P =.006). Rice, a clinical research coordinator at Massachusetts General Hospital, noted that there are a multitude of reasons for poor adherence rates. He also explained that due to the fact that oral DMTs are still relatively new, the rates of adherence to them have yet to be fully observed.

As part of a special ACTRIMS-related NeuroVoices series, Rice sat down to discuss the findings, and the overall pressing topics in MS DMT adherence. He also discussed the feasibility of the electronic pill bottle and its potential for broader clinical use.

NeurologyLive: Can you provide an outline of your study?

Dylan Rice: To go along with what you were saying about there not being a ton of variety in the different presentations, we drew some inspiration from that. Oral disease modifying therapies for MS have been available since 2010, and since then there’s been some literature on adherence rates to these oral DMTs, but most of the adherence literature in MS is focused on other types of DMTs, mainly those that are infused. The research that has been done on oral DMTs mostly uses this measured called the Medication Possession Ratio, which quantifies the number of pills that you’re supposed to take in a certain timeframe. At the end of that timeframe, you count the number of pills that you’ve taken and calculate adherence that way. Our inspiration for this project was to find a more real time measure of adherence to these oral DMTs. What we did was use this electronic pill bottle from a company called Pillsy, which is able to sync to an app on your smartphone, and it will record every time that you open and close the pill bottle to take your medication. What we were able to do was look at patterns of adherence, which is something that has not really been documented in literature before.

Is this smart cap technology something that is more feasible in clinical care or are there barriers to implementing this on a broader range?

There are obviously some idiosyncrasies for any different type of disease state. One thing that we did notice was that specifically for people with MS, if there were different levels of disability, it became harder to open the pill bottle itself because of the physical dexterity. In some patients, we had issues where this was not the only drug that they were taking, they were maybe on 6 or 7 different medications for other diseases or conditions that they had. It potentially added another layer of something that they had to remember. These patients would have a set of pills that they would normally take and then this separate pill bottle for their oral MS DMTs. In general, this was a great technology that was able to patient patients, but there are definitely some different factors that are involved in how useful this technology can actually be for a broader spectrum.

Where do some of the issues with adherence stem from?

I think disease progression definitely plays a role in adherence. But I think a lot of the factors we see affecting adherence are centered around patient life factors. Things like comorbidities such as depression, could play a role. If patients are experiencing side effects or have a fear of side effects, that would definitely play a role in adherence. And then there are everyday factors such as longer working schedules, patients who have children they need to take care of, and smaller things such as forgetfulness can definitely play a role.

I think that was actually one of the strengths of the electronic pill bottle that we were able to see. Because participants had that app, they were able to look at a log of their medications taken over the 90-day period and see if they’ve taken their pill already. A lot of them found this to be extremely useful. Even with the daily routine, taking these pills becomes a small part of what patients have to go through on a day-to-day life, so some people just completely forget if they’ve taken it or haven’t. That was definitely a major strength that we found.

What is the general feeling about the progression of treating adherence within the MS community? Do clinicians feel as though this is an issue they’re beginning to grasp?

I would say I don’t have an overarching knowledge of general adherence to drugs in the MS community, but for oral DMTs specifically, like I said, have not been available relatively for that long. I would say the research there is still pretty preliminary. I think getting this nuanced data that we’ve collected in this trial is one of the first steps in really understanding how clinicians may be able to address these issues in the future.

Is there anything else about your study you’d like to mention?

One of the main takeaways from our study that I didn’t previously mention was the virtual aspect of it. To our knowledge, we haven’t seen many virtual clinical trials conducted in the MS research realm. Just establishing the feasibility of conducting this clinical when there’s no physical interaction with patients actually lent itself to some strengths as well. More participants were available to participate in the research because they didn’t have to cut time out of their days to come to the hospital, especially during the pandemic. There was no sort of risk that they would be contracting COVID-19 to participate in the study.

Transcript edited for clarity.

For more coverage of ACTRIMS 2021, click here.

REFERENCE

Rice D, Kaplan TB, Hotan GC, et al. Electronic pill bottle monitoring to promote medication adherence for people with multiple sclerosis: a randomized virtual clinical trial. Presented at ACTRIMS Forum 2021; February 25–27, 2021. Abstract P033