Drug delivery systems: combating non-adherence with technology
Helen Henderson, senior associate, life sciences and chemistry team and Bethan Halliwell, partner, electronics, computing and physics team, Withers & Rogers discusses how to combat non-adherence with technology.
The ageing population and rise of chronic diseases are exposing a growing need for new technologies to improve medication adherence. This has been underlined by the staggering €125 billion cost of non-adherence in Europe, and the estimation that noncommunicable diseases will account for 86% of global deaths by 2050. With the health of patients on the line, the development of drug delivery systems that can help to improve adherence is crucial.
Recent innovations include the use of microrobots with claw mechanisms to enhance intravenous drug therapy and a self-powered, bioresorbable implant to deliver pain medication. Such technologies carry huge potential for patients; they reduce the responsibility of patients to self-administer drugs and make treatments more targeted and effective. Advancements in tracking applications have also reduced the onus on patients to remember to take medication at regular intervals, or which drugs to take at what time.
The root of non-adherence
Bespoke software can bring benefits for patients and especially paediatric and geriatric demographics, where the incidence of non-adherence is greatest. For example, among children, non-adherence is often attributed to parental concerns about the adverse side effects of a particular treatment, or the child’s lack of involvement in any clinical decision-making. For older patients, non-adherence tends to be caused by the need to juggle different medications to treat multiple health issues, or they're living alone, without a family member or caregiver to help with drug administration. Research has also shown that older patients living with cognitive impairment and depression are more likely not to adhere to their treatment plan.
Other factors impeding adherence include a lack of consistency between the prescription and administration instructions on medication packaging; leaving the patient to second guess the dosage. The delayed benefit of treatment is another cause, increasing the likelihood that patients will discontinue their medication or avoid it altogether. SSRI antidepressants are a notorious example with noticeable improvements taking up to four weeks to transpire – a considerable downside for patients suffering from mental ill health who require immediate relief. The adverse side effects of treatment can also contribute to non-adherence, especially in cases where they are more severe or outweigh the benefits. For example, in a sample of patients living with chronic myeloid leukaemia, the greatest barriers impacting adherence to oral anticancer agents included difficulties with recall and side effects.
Battling confirmation bias
The spread of medical misinformation in the digital age has increased the likelihood of non-adherence. This is largely due to confirmation bias - a tendency for individuals to seek out and interpret information to reinforce their existing beliefs or ideas. In a medical context, this can be extremely detrimental to patient health and impact their recovery, particularly in situations where information about drug administration or the side effects of a particular treatment are based on speculation rather than scientific fact. In some cases, social media content can perpetuate confirmation bias. Recent trends reveal that TikTok is increasingly being used to self-diagnose complex neurological conditions, such as autism and ADHD, which experts have warned could lead to misdiagnosis and the production of inappropriate treatment plans.
In the past few years, the consequences of misinformation have been illustrated on several occasions. For example, post-pandemic studies have linked hesitancy or refusal of the COVID-19 vaccine with exposure to misinformation suggesting that they carry a microchip, which could alter the patient’s DNA or even be fatal. Similar behavioural responses were observed following the gastroenterologist, Andrew Wakefield’s now discredited hypothesis, that the MMR vaccine could cause autism.
Technology is the way forward
It is widely accepted that combating non-adherence will require the development of more effective drug delivery systems. The transformation of mechanisms for administering treatments has already been shown to vastly improve patient outcomes. Glucose-responsive insulin patches have revolutionised the regulation of glucose levels in people with diabetes, limiting the need for this to be achieved via injections. Software can also help patients to monitor blood glucose levels, track their diet and exercise regimens, and provide insights into general health. As a credible, personalised source of information, these tools enable patients to play a role in managing their own conditions and make treatment an easier and more certain journey.
Nanomedicine and adherence
One of the biggest areas of technological advancement is focused on improving the way cancer treatments are administered in order to improve patient outcomes. Over the past two decades, remarkable headway has been made in modifying chemotherapies to boost success rates and minimise side effects. Nanomedicine has been leading the way, enabling an increasingly precise delivery of chemotherapy to reduce the damage inflicted to the body’s healthy cells. Researchers from the University of Queensland recently developed a silica nanoparticle that speeds up the transmission of the chemo agent, temozolomide, through the blood brain barrier. In turn, this provides a quicker penetration of an aggressive type of brain tumour, known as a glioblastoma, facilitating a more targeted treatment.
A similar approach was adopted by researchers from Yale and the University of Connecticut who also used a nanoparticle-based treatment to attack glioblastomas. The bioadhesive nanoparticles travel to the site of the tumour before releasing peptide nucleic acids to target the overexpressed microRNAs that enable the fast growth of cancer cells. This treatment can target two types of microRNAs, making it much more effective. Delivering chemotherapies in this way could eventually reduce the need for multiple rounds of treatment and boost the chances of eliminating cancerous cells. As a result, the problems associated with patients’ non-adherence to chemotherapy agents could reduce significantly.
Patenting drug delivery systems
In the early stages of developing a new treatment, innovators should be mindful of patient needs. To limit non-adherence, it is important that administration methods are both efficient and effective, and patients should be protected from any physical or psychological impacts as far as possible. Securing a patent early on for a novel means of administration is key to securing the funding needed to proceed with costly clinical trials. Given the length of time it takes to undertake the necessary assessment of a new treatment or administration mechanism, starting the patent process early will help to speed the way to market.