Evaluating digital adherence support in asthma: the ADITION non-interventional study

Abstract

Background Poor adherence to asthma maintenance therapy is associated with worse outcomes. A solution could be digital adherence support. This study evaluated asthma control and adherence in patients using mometasone furoate/indacaterol/glycopyrronium (MF/IND/GLY) with a digital support system or using any inhaled corticosteroid/long-acting β2-agonist/long-acting muscarinic antagonist (ICS/LABA/ LAMA) combination without support. Methods This prospective, non-interventional, multicentre, open-label study enrolled adults with asthma in Germany. Prior to inclusion, treatment was initiated with MF/IND/GLY with digital support or with any ICS/LABA/LAMA without digital support. The primary end-point was change in Asthma Control Test (ACT) at 6 months. Results Of 222 and 203 patients in the MF/IND/GLY plus digital support and ICS/LABA/LAMA groups, 76.1% and 74.9% completed follow-up, respectively. Baseline mean ACT total scores were 17.0 and 14.7, with mean changes from baseline at 6 months of 3.0 and 4.1, respectively; following propensity matching (n=92 per group), mean changes were similar in the two groups, with overlapping 95% confidence intervals (2.9 (95% CI 1.9–3.9) and 4.0 (95% CI 3.0–5.1), respectively). At enrolment, patients were overall moderately adherent to maintenance therapy, with limited changes over the study. The overall incidence of adverse events was similar in the two groups (29.5% and 27.3% of patients, respectively). Conclusions Patients using MF/IND/GLY with digital support had similar improvements in asthma control to those receiving ICS/LABA/LAMA alone, with minimal changes in adherence. These results illustrate the challenges in evaluating asthma control and adherence in non-interventional studies. Further studies are required to evaluate the value of digital support systems and how they can be used to optimise inhaler adherence.