Electronically monitored medication adherence in idiopathic pulmonary fibrosis: prevalence, predictors and outcomes

Study flowchart (n=55). “Study discontinuation” refers to the patients who had a data collection point planned but discontinued the study (e.g. deceased, medication switch).“No data collection” refers to the patients who did not have a new data collection point planned and thus ended the study as anticipated (e.g. due to the prospective inclusion and design of the study).

Chronology plots of four participants. Chronology plots allow us to visualize any missing or extra drug intake, drug holidays, timing of intake, consistency in timing and taking and discontinuation. Dates are shown on the x-axis (calendar) and time (24-h clock) is shown on the y-axis. Three daily pirfenidone doses at mealtime are recommended for idiopathic pulmonary fibrosis patients: coloured dots are bottle openings (i.e. presuming medication intake): purple (morning dose), green (midday dose) and yellow (evening dose). The grey bars are points where no medication intake (i.e. opening bottle) are monitored and the red lines refer to study visits. a) Participant one took pirfenidone at times that varied greatly and missed several doses, especially at the end of the monitoring. The patient had 78.2% of days with correct dosing of pirfenidone. This reflects a poor implementation pattern. The patient stopped using the bottle without discontinuing the treatment. b) Patient two had two registered non-monitoring periods at the beginning of treatment, yet the plot shows two additional periods for which no reason was provided (i.e. considered as long drug holidays). Also, multiple intakes were missed, including short drug holidays. During the monitored period, the patient only had 59.4% of correct dosing days. c) Patient three had a regular timing adherence and only missed two doses during the monitoring period of 10 months. More specifically, the patient had 99.3% of correct dosing days. d) Patient four had similar adherence pattern as patient three but showed issues in taking adherence early after treatment initiation and especially for the timing point at the midday meal. During the monitored period, the patient had 94.8% of correct dosing days.