Ingestible Sensors and Medication Adherence: Focus on Use in Serious Mental Illness

Abstract

Background: Poor medication adherence is a major public health concern. Patients living with a serious mental illness (SMI) commonly present with non-adherence to their medication regimen, which can lead to relapse and hospitalizations. The high rates of antipsychotic non-adherence continue to persist despite several interventions and medication advances. This review evaluates the possible role of the ingestible sensor technology for medication adherence in different conditions, with a focus on use in the SMI schizophrenia. Methods: Literature searches were conducted in July 2019 in the PubMed database. Results: In small studies of ingestible sensor use, the average adherence ranged from 73.9% to 88.6% for SMI and ≥ 80% for cardiac and transplant (99.4%) patients. In SMI studies, patients were clinically stable, and the majority had a clinical global impression severity of “mild disease”. Patients generally experienced relatively minor dermatological adverse effects related to wearable sensor use. Conclusions: A medication with an ingestible sensor may help provide real-time objective medication-taking adherence information for clinicians. However, further studies are needed to understand the impact of use on adherence and improvement on treatment outcomes with the ingestible sensor technology.

Capillary Microfluidics for Monitoring Medication Adherence

“…Over the past decades, nanotechnology‐based formulations have continued to contribute to medicine and food sectors through enhanced drug or biosensor delivery, tailored pharmacokinetics, improved food bioavailability, food processing, and preservation, which spurred formation of specialised expertise around nanotechnology in regulatory bodies [136] . Furthermore, the approval of Abilify MyCite in 2017 as the first drug–device combination product to digitally track ingestion of an antipsychotic drug set ground for in vivo sensing components entering the medication adherence space [116] . Technology alone cannot solve the challenge of medication adherence, but we believe that simple‐to‐use microfluidic devices showing that drugs were taken safely and timely by a patient may provide an extremely useful tool in this matter.…”

Psychiatry in the Digital Age: A Blessing or a Curse?

“…The digital medicine system (DMS) represents a novel and quite radical step towards further improvement of medication adherence. The DMS includes the following elements [138][139][140][141][142][143]: First, a sensor smaller than a sesame seed, contained in the pill and activated upon interaction with stomach fluid, is ingested. After activation, the sensor sends a signal with a specific code.…”

“…In psychiatry, the DMS has been investigated in three small studies in patients with schizophrenia, bipolar disorder, and major depressive disorder [138,139,141,143]. In one of those studies, the ingestible sensor was embedded within tablets containing a placebo [138].…”

“…In the other two studies, the sensor was embedded within pills containing various dosages of aripiprazole [139,141]. The reported medication adherence ranged from 74% to 89% [138,139,141,143]. The DMS was generally well-tolerated.…”

“…There was no prospective, double-blind, randomized controlled trial comparing digital aripiprazole with a non-digital formulation or placebo [145]. In addition, controlled trials are needed to investigate treatment outcomes, such as remission rate and quality of life, to understand the clinical impact of digital aripiprazole [143]. Furthermore, digital aripiprazole needs to be tested in severely ill patients, since published studies enrolled patients who were moderately ill and in stable condition on non-digital oral aripiprazole [143].…”