Category: Professional Posters
Purpose: Ibrutinib is an oral tyrosine kinase inhibitor indicated as front line therapy for multiple different blood cancers. The goal of therapy with ibrutinib is unique, as patients continue with therapy long term in order to remain in remission. A study evaluating ibrutinib treatment discontinuation demonstrated that continuous treatment with ibrutinib improves quality and frequency of responses over time, including that for rates of complete response. The purpose of this study is to evaluate the effect of a smart pill lid (SPL) on medication persistence, adherence, and increased number of pharmacist interventions in patients who are treated with ibrutinib.
Methods: Patients new to ibrutinib therapy were offered enrollment into the study during pharmacist counsel or mid-therapy calls. Eligible patients included those who were 18 years of age or older, new to treatment within at least 30 days and prescribed ibrutinib 140 mg capsules. Patients were randomized in a 1:1 fashion to receive an SPL with full notifications turned on (intervention) or an SPL with notifications turned off (control). All SPLs were connected to a real time dashboard which records and tracks time of bottle opening. Patients in the intervention group were monitored and subject to pharmacist adherence follow up calls if weekly adherence measures fell below goal (≥ 2 missed doses, < 85% adherence). A historical cohort from January 2018 was also compared to the intervention group. Chi square analysis was used to compare persistence rates at fills 2, 4 and 6 utilizing pharmacy prescription refill records. Adherence rates were compared utilizing the proportion of SPL opens and analyzed using a students t-test. Descriptive statistics were used to evaluate pharmacist interventions and patient satisfaction surveys. For all tests, a p value < 0.05 was considered significant.
Results: A total of 67 patients were included in the study, with 31 in the intervention group and 36 in the control group. Results showed increased persistence to therapy at fill four in the intervention group compared to the control group (74% vs 44%, ᵡ2 = 8.56, p = 0.01) and to the historical cohort (74% vs 22%, ᵡ2 = 35.42, p < 0.01). Patients in the intervention group had higher mean adherence rates based on proportion of SPL opens (93% vs 65%, p < 0.01). The intervention group recorded a significantly higher percentage of on time doses (93% vs 62%, p < 0.01) and significantly few late doses (1.2% vs 6.7%, p < 0.01). Of the patients in the intervention group, 11 of 31 were flagged for adherence follow up calls and 24 pharmacist interventions were completed.
Conclusion: The SPL significantly increased adherence and persistence to therapy in the intervention group. Based on the increased percentage of on time doses recorded, the intervention group appears more likely to take their medication at the same time each day. Pharmacist monitoring and targeted adherence outreach may contribute to increased adherence and persistence to ibrutinib therapy. Long term follow up is necessary to appropriately evaluate the continued effect of smart pill lid use.