Transplant Trial Watch

Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGETM results of the MAGIC randomized clinical trial.

Russell, C. L., Hathaway, D. et al. (2019).

American Journal of Transplantation 10:10.


Aims
The objective of this study was to determine if a SystemCHANGETM intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6-month intervention phase and a subsequent 6-month (no intervention) maintenance phase.

Interventions
Patients were randomly assigned to a 6 month SystemCHANGETM intervention or a no intervention, maintenance phase. The SystemCHANGETM approach taught patients to use person-level quality improvement strategies to link adherence to established daily routines.

Participants
There were 89 kidney transplant patients which participated in this study.

Outcomes
Primary outcome was assessed as the average 6-month immunosuppressive medication adherence rate, which was defined as doses taken on time/total doses as measured by the Medication Event Monitoring System SmartCap® (MEMSCap™). The secondary outcome was adherence of immunosuppressive medication at 12 months.

Follow-up
12 months

CET Conclusions
This interesting RCT investigates the use of a behavioural intervention (SystemChange) to improve medication adherence following renal transplantation. Patients were randomized to intervention or control, and the authors demonstrate a significant improvement in adherence following the intervention, which importantly is preserved for 6 months after the intervention is complete. Interventions that demonstrate sustained improvement in adherence in transplant recipients are far and few between, so these findings are important. However, it is not clear from this study how easy it would be to implement the intervention outside of the trial setting as it is quite resource intensive. Whilst the intervention effect was sustained in patients for 6 months after completion, this was with a stipend and continued electronic pill monitoring. It is possible that the effect will reduce over time outside of a trial. A pragmatic real-world trial in more centres would help to answer some of these outstanding questions.

Jadad score
3

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
ClinicalTrials.gov - NCT02416479

Funding source
Not reported