1
|
Jan M, Coppin-Renz A, West R, Gallo CL, Cochran JM, Heumen EV, Fahmy M, Reuteman-Fowler JC. Safety Evaluation in Iterative Development of Wearable Patches for Aripiprazole Tablets With Sensor: Pooled Analysis of Clinical Trials. JMIR Form Res 2023; 7:e44768. [PMID: 38085556 PMCID: PMC10751624 DOI: 10.2196/44768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/16/2023] [Accepted: 09/23/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Wearable sensors in digital health may pose a risk for skin irritation through the use of wearable patches. Little is known about how patient- and product-related factors impact the risk of skin irritation. Aripiprazole tablets with sensor (AS, Abilify MyCite; Otsuka America Pharmaceutical, Inc) is a digital medicine system indicated for the treatment of patients with schizophrenia, bipolar I disorder, and major depressive disorder. AS includes aripiprazole tablets with an embedded ingestible event marker, a wearable sensor attached to the skin through a wearable patch, a smartphone app, and a web-based portal. To continuously improve the final product, successive iterations of wearable patches were developed, including raisin patch version 4 (RP4), followed by disposable wearable sensor version 5 (DW5), and then reusable wearable sensor version 2 (RW2). OBJECTIVE This analysis pooled safety data from clinical studies in adult participants using the RP4, DW5, and RW2 wearable patches of AS and evaluated adverse events related to the use of wearable patches. METHODS Safety data from 12 studies in adults aged 18-65 years from May 2010 to August 2020 were analyzed. All studies evaluated safety, with studies less than 2 weeks also specifically examining human factors associated with the use of the components of AS. Healthy volunteers or patients with schizophrenia, bipolar I disorder, or major depressive disorder were enrolled; those who were exposed to at least 1 wearable patch were included in the safety analysis. Adverse events related to the use of a wearable patch were evaluated. Abrasions, blisters, dermatitis, discoloration, erythema, irritation, pain, pruritus, rash, and skin reactions were grouped as skin irritation events (SIEs). All statistical analyses were descriptive. RESULTS The analysis included 763 participants (mean [SD] age 42.6 [12.9] years; White: n=359, 47.1%; and male: n=420, 55%). Participants were healthy volunteers (n=269, 35.3%) or patients with schizophrenia (n=402, 52.7%), bipolar I disorder (n=57, 7.5%), or major depressive disorder (n=35, 4.6%). Overall, 13.6% (104/763) of the participants reported at least 1 SIE, all of which were localized to the wearable patch site. Incidence of ≥1 patch-related SIEs was seen in 18.1% (28/155), 14.2% (55/387), and 9.2% (28/306) of participants who used RP4, DW5, and RW2, respectively. Incidence of SIE-related treatment discontinuation was low, which is reported by 1.9% (3/155), 3.1% (12/387), and 1.3% (4/306) of participants who used RP4, DW5, and RW2, respectively. CONCLUSIONS The incidence rates of SIEs reported as the wearable patch versions evolved from RP4 through RW2 suggest that information derived from reported adverse events may have informed product design and development, which could have improved both tolerability and wearability of successive products. TRIAL REGISTRATION Clinicaltrials.gov NCT02091882, https://clinicaltrials.gov/study/NCT02091882; Clinicaltrials.gov NCT02404532, https://clinicaltrials.gov/study/NCT02404532; Clinicaltrials.gov NCT02722967, https://clinicaltrials.gov/study/NCT02722967; Clinicaltrials.gov NCT02219009, https://clinicaltrials.gov/study/NCT02219009; Clinicaltrials.gov NCT03568500, https://clinicaltrials.gov/study/NCT03568500; Clinicaltrials.gov NCT03892889, https://clinicaltrials.gov/study/NCT03892889.
Collapse
Affiliation(s)
- Michael Jan
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | | - Robin West
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | - Christophe Le Gallo
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
- Genmab US, Inc, Plainsboro, NJ, United States
| | - Jeffrey M Cochran
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | | - Michael Fahmy
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | |
Collapse
|
2
|
Hadzi Boskovic D, Liang S, Parab P, Wiggins E, Liberman JN. Real-World Evidence of Aripiprazole Tablets with Sensor: Treatment Patterns and Impacts on Psychiatric Healthcare Resource Utilization. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:487-498. [PMID: 37377843 PMCID: PMC10292208 DOI: 10.2147/ceor.s402357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose Maintaining adherence to antipsychotic (AP) medication is often challenging. Aripiprazole tablets with sensor (AS) contain an ingestible event marker and communicate with wearable patches and a smartphone app to provide objective medication ingestion data. This study evaluated real-world treatment patterns of AS usage and its impact on psychiatric healthcare resource utilization (HCRU). Patients and Methods This retrospective, observational cohort study identified individuals who initiated AS between 1/1/2019 and 6/30/2020 with 3 months baseline and 6 months of follow-up data using a commercial medical and pharmacy claims database (Clarivate). Controls were propensity score-matched (4:1) to AS initiators based on age (±2 years), sex, diagnosis (major depressive disorder [MDD], schizophrenia, bipolar I disorder [BP-I], other), insurance, and baseline oral AP use (yes/no). Days of AP supply were evaluated using a general regression model. The frequency of psychiatric HCRU during follow-up was compared between groups using a zero-inflated regression model. Results Most AS initiators were diagnosed with MDD (61.2%) and were women (61.2%); mean age was 37.7 years (standard deviation: 14.1). Most AS initiators (53.1%) continued treatment for >60 days (mean days of supply = 77). After adjusting for covariates, AS initiators had 41% more days of AP supply during follow-up compared with controls (P <0.0001) and significantly lower adjusted odds ratios (ORs) for psychiatric outpatient visits (adjusted OR = 0.80; P <0.05), emergency department visits (adjusted OR = 0.11; P <0.05), inpatient visits (adjusted OR = 0.42; P <0.05), and other medical services (adjusted OR = 0.25; P <0.05). Conclusion Participants who implemented AS had significantly more days of AP supply and fewer psychiatric care visits. These preliminary results suggest AS usage can help build regular medication-taking habits and holds promise for reducing psychiatric HCRU. Additional studies with larger sample sizes are warranted to inform clinical practice and coverage decisions.
Collapse
|
3
|
Litvinova O, Klager E, Tzvetkov NT, Kimberger O, Kletecka-Pulker M, Willschke H, Atanasov AG. Digital Pills with Ingestible Sensors: Patent Landscape Analysis. Pharmaceuticals (Basel) 2022; 15:ph15081025. [PMID: 36015173 PMCID: PMC9415622 DOI: 10.3390/ph15081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
The modern healthcare system is directly related to the development of digital health tools and solutions. Pills with digital sensors represent a highly innovative class of new pharmaceuticals. The aim of this work was to analyze the patent landscape and to systematize the main trends in patent protection of digital pills with ingestible sensors worldwide; accordingly, to identify the patenting leaders as well as the main prevailing areas of therapy for patent protection, and the future perspectives in the field. In July 2022, a search was conducted using Internet databases, such as the EPO, USPTO, FDA and the Lens database. The patent landscape analysis shows an increase in the number of patents related to digital pills with ingestible sensors for mobile clinical monitoring, smart drug delivery, and endoscopy diagnostics. The leaders in the number of patents issued are the United States, the European Patent Office, Canada, Australia, and China. The following main areas of patenting digital pills with ingestible sensors were identified: treatment in the field of mental health; HIV/AIDS; pain control; cardiovascular diseases; diabetes; gastroenterology (including hepatitis C); oncology; tuberculosis; and transplantology. The development of scientific and practical approaches towards the implementation of effective and safe digital pills will improve treatment outcomes, increase compliance, reduce hospital stays, provide mobile clinical monitoring, have a positive impact on treatment costs and will contribute to increased patient safety.
Collapse
Affiliation(s)
- Olena Litvinova
- Department of Management, Economy and Quality Assurance in Pharmacy, National University of Pharmacy, The Ministry of Health of Ukraine, 61002 Kharkiv, Ukraine
- Correspondence: (O.L.); (A.G.A.); Tel.: +380-67-300-78-49 (O.L.); +43-1401-6036-250 (A.G.A.)
| | - Elisabeth Klager
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
| | - Nikolay T. Tzvetkov
- Institute of Molecular Biology “Roumen Tsanev”, Department of Biochemical Pharmacology and Drug Design, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Oliver Kimberger
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Institute for Ethics and Law in Medicine, University of Vienna, 1090 Vienna, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1180 Vienna, Austria
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
- Correspondence: (O.L.); (A.G.A.); Tel.: +380-67-300-78-49 (O.L.); +43-1401-6036-250 (A.G.A.)
| |
Collapse
|
4
|
Taub S, Krivoy A, Whiskey E, Shergill SS. New approaches to antipsychotic medication adherence - safety, tolerability and acceptability. Expert Opin Drug Saf 2021; 21:517-524. [PMID: 34541978 DOI: 10.1080/14740338.2021.1983540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Antipsychotic pharmacotherapy is considered a first-line treatment in schizophrenia-related disorders and is associated with favorable prognosis and lower mortality rates. However, low adherence rates present a major clinical challenge. In this paper, we will review contemporary approaches to improve adherence to antipsychotic treatment, considering their mechanism of action, safety, tolerability and acceptability. AREAS COVERED Novel pharmacological delivery methods included different routes of administration of registered medications (such as intramuscular clozapine preparation and transdermal asenapine), modifications of existing compounds (such as 3-monthly injectable formulation of paliperidone palmitate), and increased interest in oral long-acting medication formulations (such as with penfluridol). In addition, we reviewed innovative technology to monitor adherence, based on the use of electronic digital medicine systems and ingestible sensors. EXPERT OPINION All of these diverse approaches were clinically relevant in enhancing treatment adherence and found to be safe and tolerable. The place of each approach is predicated on a personalized approach in each patient, and future research could usefully use large comparative studies to establish robust treatment guidelines. The implementation of new and varied approaches to antipsychotic treatment adherence is welcomed and have the potential to make a significant impact on morbidity in this often difficult-to-treat population.
Collapse
Affiliation(s)
- Sharon Taub
- Geha Mental Health Center, Petach-Tikva, Israel
| | - Amir Krivoy
- Geha Mental Health Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eromona Whiskey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,National Psychosis Unit, South London and Maudsley NHS Foundation Trust, London, UK.,Kent and Medway Medical School, Canterbury, UK
| |
Collapse
|
5
|
Curto M, Fazio F, Ulivieri M, Navari S, Lionetto L, Baldessarini RJ. Improving adherence to pharmacological treatment for schizophrenia: a systematic assessment. Expert Opin Pharmacother 2021; 22:1143-1155. [PMID: 33543659 DOI: 10.1080/14656566.2021.1882996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Poor adherence to pharmacological treatment is prevalent in schizophrenia, affecting more than half of patients at some time, with increased risks of clinical worsening, adverse outcomes, suicide, and increased resource utilization including hospitalization, with higher costs.Areas Covered: This review considers factors associated with treatment-nonadherence among schizophrenia patients, with a systematic evaluation of interventions aimed at improving adherence with an emphasis on evidence arising from their testing.Expert opinion: Several interventions have addressed factors empirically associated with treatment-nonadherence, including various drug-, patient - and clinical services-associated factors. They include long-acting injected (LAI) drug formulations, behavioral interventions, and technology-supported methods. Use of LAI antipsychotics and behavioral techniques aimed at incorporating medicine-taking into daily routines with electronic monitoring have been assessed relatively extensively. Mobile, digital applications including medication monitoring systems and artificial intelligence-based interactions are emerging but have been tested in few trials of limited quality with inconclusive results. Randomized, controlled, blinded trials based on clinically representative samples are needed to evaluate not only adherence, but also to test for clinically meaningful and sustained clinical benefits in schizophrenia patients, who are especially difficult to treat.
Collapse
Affiliation(s)
- Martina Curto
- Department of Mental Health, Rome, Italy.,International Consortium for Mood Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, USA
| | - Francesco Fazio
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Martina Ulivieri
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Serena Navari
- Department of Mental Health, Colleferro (Rome), Italy
| | - Luana Lionetto
- Advanced Molecular Diagnostics Unit, Sant'Andrea Hospital, Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood Psychotic & Mood Disorders Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Fowler JC, Cope N, Knights J, Fang H, Skubiak T, Shergill SS, Phiri P, Rathod S, Peters-Strickland T. Hummingbird Study: Results from an Exploratory Trial Assessing the Performance and Acceptance of a Digital Medicine System in Adults with Schizophrenia, Schizoaffective Disorder, or First-Episode Psychosis. Neuropsychiatr Dis Treat 2021; 17:483-492. [PMID: 33603385 PMCID: PMC7886232 DOI: 10.2147/ndt.s290793] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/23/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Symptoms of psychotic disorders can complicate efforts to accurately evaluate patients' medication ingestion. The digital medicine system (DMS), composed of antipsychotic medication co-encapsulated with an ingestible sensor, wearable sensor patches, and a smartphone application, was developed to objectively measure medication ingestion. We assessed performance and acceptance of the DMS in subjects with psychotic disorders. METHODS This was an 8-week open-label, single-arm, multicenter, Phase 4 pragmatic study (NCT03568500; EudraCT #2017-004602-17). Eligible adults were diagnosed with schizophrenia, schizoaffective disorder, or first-episode psychosis; were receiving aripiprazole, quetiapine, olanzapine, or risperidone; and could use the DMS with the application downloaded on a personal smartphone. The primary endpoint was good patch coverage, defined as the proportion of days over the assessment period where ≥80.0% of patch data was available, or an ingestion was detected. Exploratory endpoints included a survey on user satisfaction, used to assess acceptance of the DMS. Safety analyses included the incidence of treatment-emergent adverse events (TEAEs). RESULTS From May 25, 2018 to March 22, 2019, 55 subjects were screened and 44 were enrolled. Good patch coverage was achieved on 63.4% of days assessed and the DMS generated an adherence metric of ≥80.0%, reflecting the percentage of ingestion events expected when good patch coverage was reported. Most subjects (53.5%) were satisfied with the DMS. Medical device skin irritations were the only TEAEs reported. CONCLUSION The DMS had sufficient performance in, and acceptance from, subjects with psychotic disorders and was generally well tolerated.
Collapse
Affiliation(s)
- J Corey Fowler
- Global Clinical Development, CNS and Digital Medicine, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Nathan Cope
- Program Management, Otsuka Pharmaceutical Europe Ltd., Wexham, SL3 6PJ, UK
| | - Jonathan Knights
- Data Insights and Analytics, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Hui Fang
- Biostatistics, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Taisa Skubiak
- Clinical Management, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| | - Sukhi S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, SE5 8AF, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Moorgreen Hospital, Clinical Trials Facility, Research Department, Southampton, SO30 3JB, UK
| | - Shanaya Rathod
- Southern Health NHS Foundation Trust, Moorgreen Hospital, Clinical Trials Facility, Research Department, Southampton, SO30 3JB, UK
| | - Timothy Peters-Strickland
- Global Clinical Development, CNS and Digital Medicine, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, 08540, USA
| |
Collapse
|
7
|
Thibaudeau E, Raucher-Chéné D, Lecardeur L, Cellard C, Lepage M, Lecomte T. Les interventions psychosociales destinées aux personnes composant avec un premier épisode psychotique : une revue narrative et critique. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088184ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|