Observations on the Effect of Electronic Needle Container on Adherence to Adalimumab
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CORRESPONDENCE
Observations on the Effect of Electronic Needle Container on Adherence to Adalimumab John Armstrong1 · Sharifah Sarhan1 Received: 30 July 2020 / Accepted: 21 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
In this multicentre, non-randomized 12-month observational study, they included patients with adalimumab-treated inflammatory bowel disease. The patients were non-adalimumab-naive and may have been self-selected to be more compliant than the general population. All patients were invited to receive an electronic needle container (ENC). The “ENC” manufactured by HealthBeacon is a smart sharps bin which photographs syringes being “dropped” into the device after they are used. Patients who declined or did not complete the registration for an ENC served as controls, which may represent a potential source of bias in this study. The primary endpoint was whether an ENC increased adherence, calculated from pharmacy refills as proportion of days covered (PDC). There was no significant difference in the primary endpoint between those with and without an ENC. They concluded that their results “show no beneficial effect of a reminder-based intervention on adherence or treatment outcomes.” However, this misses the putative benefit of an ENC which is real-time monitoring of medication adherence, to enable the provision of targeted support for patients. In this study, no real-time support was given to the ENC cohort. They analyzed the relationship between PDC and actual injections (as measured by electronically documented episode of needles being placed in the smart sharps bin). They evaluated the test characteristics of the PDC calculated from pharmacy refills during follow-up with adherence from the ENC. The correlation between PDC and actual drops was poor. The AUC for that comparison was only 0.64. Therefore, what this study demonstrates is simply that assessment of adherence with PDC or other measures of medical * Sharifah Sarhan [email protected] John Armstrong [email protected] 1
HealthBeacon Limited, Unit 20, Naas Road Business Park, Murifield Drive, Dublin 12, Ireland
possession ratios does not correlate well with actual adherence. Hence, this study was unable to conclusively correlate PDC with ENC adherence. Therefore, devices such as the HealthBeacon may assist in improving adherence by identifying non-adherent patients in real-time and focusing appropriate supports to improve adherence.
Reply We welcome the opportunity to respond to the correspondence by Drs. Armstrong and Sarhan regarding our recent publication describing the results of a non-randomized 12-month observational study on improving adherence by means of an electronic needle container (ENC) [HealthBeacon(™)] [1]. We agree that the design of this study could have led to self-selection bias, i.e., where more adherent patients are more likely to accept this intervention compared to nonadherent patients. Indeed, at baseline we did observe more adherent patients in the group
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