Long-term adherence to topical psoriasis treatment can be abysmal: a 1-year randomized intervention study using objective electronic adherence monitoring

Abstract

This study likely underestimates the challenge of long-term adherence, as adherence tends to be better in research studies than in clinical practice. This study also did not fully account for primary nonadherence. Adherence to topical treatment is low in the short term and decreased further in the long term, a considerable challenge for dermatologists to address. A reporting intervention may be one of the ways we can improve our patients' treatment outcomes.

Outcome measures for adherence data from a medication event monitoring system: A literature review

“…In some studies, multiple openings were counted as 1 opening if the bottle was opened several times within 15 or 30 minutes of the previous opening. Unexpected openings outside this time window were assumed to represent a taken dose…”

“…We did not find any relation between these health conditions and the methods that were used to summarize the MEMS data. MEMS is often seen as the reference standard to measure medication adherence, but it still assumes that one bottle opening equals the intake of one medication dose, a simplification that cannot be easily checked . For example, a patient could open the bottle and either not take any or more than the appropriate dose.…”

Rapid onset of action of calcipotriol/betamethasone dipropionate cutaneous foam in psoriasis, even in patients with more severe disease

“…The speed of onset of action of topical treatment is rarely taken into consideration as a specific outcome in clinical trials, and our findings provide important data to support earlier timepoints for the assessment of efficacy. Furthermore, while patient adherence is multifactorial and dependent on many intrinsic and extrinsic factors, rapid improvement in disease characteristics is important to patients and is a key factor for adherence and managing psoriasis . The rapid onset of action is likely to positively contribute to patients’ treatment adherence, while the absolute targets will assist expectation management by the treating physician in patients with psoriasis treated with Cal/BD foam.…”

Every dermatology consultation: think adherence

“…Furthermore, there is dissipation of scarce resources and clinicians get an inaccurate understanding of the appropriateness and effectiveness of the advice they gave. In this issue of the BJD, Alinia et al 5 examine long-term adherence to topical medication and demonstrate that it is 'abysmal'. Theirs is a critical expos e, striking at the heart of one of the main tenets of clinical practice.…”

“…There is considerable experience of this from clinical trials where even self-completed diary entries are sometimes falsified. That's why in the research context the technique described in this issue by Alinia et al 5 of covert electronic monitoring of therapy treatment containers is exciting. It is possible to imagine that the use of such electronic devices could be used overtly to assist patient adherence.…”