Remote Technology Improves Adherence Rates in Relapsing MS


The authors expanded upon the notion that nonadherence to oral DMTs is more nuanced than simply missing doses.

Dylan Rice

Dylan Rice

A reminder system using electronic smart caps from a pill bottle paired with remote smartphone app technology produced greater rates of adherence for people with multiple sclerosis (PwMS), but still suggested that developing strategies to improve adherence to oral disease-modifying therapies (DMTs) remains a need within MS care.1

The results of the study were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2021, February 25–27, by Dylan Rice, clinical research coordinator, Massachusetts General Hospital. Rice and colleagues collected data on 85 PwMS who were randomized 1:1 to remote smartphone app- and bottle-based adherence tracking alone versus adherence tracking with medication reminders.

Overall, the average perfect adherence over the 90-day study period for all participants was 65% (standard deviation [SD], 21.2; range, 14.2-98.9). Average perfect adherence was statistically significantly higher in the reminders arm (68%) compared to the monitoring only arm (61.4%; P =.006). Notably, there was no difference observed in perfect adherence by once versus twice daily dosing.

"Because participants had the app where they could look at a log of the medications they were taking over this 90-day study period, we found that a lot of participants reported it was extremely useful in being able to look back at that record and see if they’ve taken their pill already,” Rice told NeurologyLive.

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Of 5959 total scheduled doses in the monitoring only arm, 4% were taken early, 61.4% on time, 5.6% late, 4.7% in excess, and 24.4% not at all. Of 7135 doses in the reminders arm, 3.4% were taken early, 68% on time, 3.7% late, 12.2% in excess, and 12.8% not at all.

All participants completed baseline health history surveys such as the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test (SDMT) and were followed for 90 days. Perfect adherence was defined as the proportion of doses a participant took within 3 hours of the scheduled time.

The electronic smart caps were designed by Pillsy, which has a multitude of features to track patient medication adherence. Pillsy marks the dose as taken when the user opens the bottle, with no need to open the app. Data is stored on the device and syncs opportunistically, even when the app is not opened on the smartphone.2 Users get smart reminders when they forget a dose and can be sent via app notification, test message, or automated phone call. The software also keeps track of remaining medications or vitamins and can order refills when more are needed.

Rice went on to say, "in general, this was a great technology that was able to help patients, but there are definitely some different factors that are involved in how useful this technology can be if it was implemented on a broader spectrum.”

Using univariate regression analyses, older participants tended to be more perfectly adherent than younger participants (P <.001), as shown by an average perfect adherence increase of 3.2% for each 1-year increase in age. Perfect adherence in the elder half of the participants (73.1%) was higher than in younger participants (60.2%; P = .004).

In total, 81% of the participants enrolled virtually, and all participants remained virtual throughout the trial. Participants took dimethyl fumarate (n = 48), fingolimod (n = 26), teriflunomide (n = 10), and diroximel fumarate (n = 1), and had been taking that disease-modifying therapy (DMT) for an average of 4.0 (range, 0.1-10.0) years.

Use of second-line DMT was the most common, occurring in 38% of patients, whereas 31% were on first, 18% on third, and 14% were on fourth or greater. Participants took an average of 3.7 (range, 1-8) prescription pills daily.

For more coverage of ACTRIMS 2021, click here.

1. 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 2021 Forum; February 25–27, 2021. Abstract P033
2. Connected Medication Platform. Pillsy. Accessed March 1, 2021.
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