Eyeing up adherence — how connected drug delivery solutions may help
In this article, Felicity Thomas, EPM editor, discusses connected solutions for drug delivery in the ophthalmic space and how this may help with patient adherence among other things with Fanny Sellier, global category manager for ophthalmic devices from Nemera.
With an ageing population and increasing numbers of patients suffering from chronic eye conditions that require regular topical treatment, effective drug delivery and patient adherence to treatment regimens are important considerations within ophthalmology.
Conditions, such as dry eye and glaucoma, can require the patient to administer eye drops consistently over a long period of time. However, according to multiple studies, medication adherence for glaucoma — a leading cause of irreversible blindness worldwide — is commonly found to be low.1–4
There are several factors that can attribute to this low adherence rate, such as a lack of understanding by the patient about the condition and the necessity of following a strict treatment schedule, uncomfortable side effects of the medication as well as difficulty in administering the treatment, to name a few.
Although the ophthalmologist can help the patient to understand the gravity of their condition and as such the importance of taking their medication, the latter two issues need to be addressed by the drug and delivery device manufacturer(s).
Nemera — a developer and manufacturer of drug delivery devices — has looked into improving patient adherence of ophthalmic treatments extensively discussing the issue with both patients and doctors.
“The quality and success of a treatment depend on the patients’ adherence,” said Sellier. “Underdosing, because of either poor adherence or poor performance, means that patients are not receiving the prescribed medication. Overdosing, as seen in a 2009 American Medical Association’s study, has the potential for several problems, including systemic or ocular adverse events and a more rapid use of the medication.”5
An easy solution with less side effects?
“Our objective was to come up with an innovative system to deliver eye drops easily into patients’ eyes and limit negative side effects, in order to improve their compliance to treatment,” Sellier added.
Working on a suitable solution, the company is developing a connected eye dropper for multi-dose preservative-free formulations.
“Our multi-dose closing tip system, Novelia, avoids the need for preservatives in the drug and prevents bacterial contamination over the duration of treatment,”sheexplained. “Rather than relying on the antimicrobial properties of preservatives to kill any bacteria that enter the bottle, the ideal approach is to prevent any entry of bacteria into the bottle in the first place, thanks to a non-return valve system used in conjunction with a silicone membrane to filter the returning air.
“The one-way valve ensures that no contaminated liquid can be re-introduced to the container after the drop has been dispensed, completely removing the need to filter the liquid,” Sellier continued. “The intake of air into the dispenser takes place via a separate venting system with a silicone membrane called the PureFlow Technology.”
Being able to use a formulation without requiring preservative should help improve adherence as potential side effects will be reduced. Preservatives can cause allergic reactions/irritations in some patients and in some extreme cases can cause a toxic response.5
Electronic add-on technology
“Digital enhancement can assist with drug delivery through aiding the patient with administration while also being able to give them reminders about when their next dose is due and enabling more detailed information to be gathered,” stated Sellier.
Using smart add-on technology, the patient benefits from digitalised and interactive instructions via their mobile device as well as an on-device screen. Patient awareness can be increased with reminders of when to take a dose as well as when to replace their medication.
Additionally, it is possible to store information like expiry date, dosage and batch number on a smart device and feedback along with guidance can be given to the patient on how to use the device in the correct way to ensure the correct dose is administered.
Obviously, there have been issues in clinical studies when trying to evaluate the relation between patient adherence and efficacy of topical treatments as once at home, patients cannot be monitored other than what they record themselves. Through a smart add-on device, a more thorough collection of data can be collated and used by the healthcare professional as well as drug manufacturer.
“The electronic add-on collects the number of drops delivered via the system and when exactly they have been delivered (date and time). It compares the actual intake with the posology and therefore calculates the patient’s compliance,” revealed Sellier. “It can also retrieve if the device has been shaken off if required. By recording the system’s inclination it is possible to ensure the right drop size is being administered.”
Useful for all!
Connected technology is finding use in many areas of life and, with rising numbers of people using smartphones or smart devices, are becoming a more routine development with far reaching possibilities and applications.
“Not only will our new technology (and connected drug delivery devices) be useful for patients, but will also be so for the entire industry,” Sellier concluded. “Healthcare professionals will benefit from dose tracking analysis and as such will be able to adjust the treatment if required; researchers will be able to perform more efficient clinical studies; the pharma companies will also be able to use the data collection to launch better performing drugs; and the payers will be able to check if the patients comply with their prescriptions.”
References:
- https://bmjophth.bmj.com/content/3/1/e000114
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274150/
- https://www.nature.com/articles/eye2012294
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038505/
- https://jamanetwork.com/journals/jamaophthalmology/article-abstract/423345
- http://www.tearfilm.org/dewsreport/pdfs/TOS-0502-DEWS-noAds.pdf