Transplant Trial Watch

Mobile medication manager application to improve adherence with immunosuppressive therapy in renal transplant recipients: A randomized controlled trial.

Han, A., Min, S. I. et al. (2019).

PLoS ONE [Electronic Resource] 14(11): e0224595.

This study aimed to evaluate if the use of the mobile medication application, Adhere4U, can improve adherence amongst renal transplant recipients, 1 year post-transplantation.

The intervention for this study was a medication manager that was developed for transplantation patients in Korea, known as Adhere4U. The app has several features, including: audible and/or visual reminders able to reflect medication tapers, nondaily administration, and start and stop dates; personal tracking data on missed and taken doses by providing a daily checklist of medication and when it was taken; medication adherence report; detailed information on all immunosuppressants; an educational video on the importance of IST; and patient’s laboratory test results. Patients were randomized to either receive conventional care (control group) or the intervention, which was the use of the Adhere4U app (mobile group).

138 renal transplant recipients (incusion criteria included being 15–70 years, an android smartphone user and current use of twice-daily tacrolimus or cyclosporine as the principal immunosuppressant following renal allograft).

The primary outcome was the nonadherence rate to index immunosuppressant (tacrolimus or cyclosporine), which was monitored using an electronic medication event monitoring system. The secondary outcome being measured was self-reported adherence using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS) and the visual analog scale (VAS) based on a 4-week recall on days 28, 90, and 180.

180 days

CET Conclusions
This interesting study from Korea investigated the effect of a smartphone medication reminder app on adherence in stable renal transplant recipients. Use of the app did not improve adherence (either measured by electronic medication monitoring or self-reported) or clinical outcomes, and sustained use of the app was poor. The manuscript is well written and there is an excellent discussion as to the potential reasons for the negative findings. There are some limitations to the study: (1) patients were enrolled between 2013 and 2015 – it is unclear how this would translate to more recent smartphones and app capabilities, (2) all patients were eligible for enrolment, rather than focussing on those that were non-adherent at baseline and (3) the treating clinician was blinded to app use, removing the potential for feedback and education to non-adherent patients during the study. Attrition in app use during the study was high and associated with poorer medication adherence, suggesting that feedback of use and adherence to the treating clinician may have the potential improve engagement and adherence.

Jadad score

Data analysis
Modified intention-to-treat analysis

Allocation concealment

Trial registration
IRB no. 1306-031-496 and NCT01905514

Funding source
Industry funded