Adherence to Adalimumab Was Not Improved by a Reminder-Based Intervention with an Electronic Needle Container

Johannes P.D. Schultheiss*, Sandra Altena, Max R. Clevers, Dominique Baas, Bindia Jharap, Herma H. Fidder

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: Adherence to adalimumab in inflammatory bowel disease (IBD) patients is reported to be below par. Non-adherence may result in loss-of-response and increased hospitalization. We analyzed the effect of an electronic needle container (ENC) on adherence to adalimumab. Methods: In this multicenter, 12-months observational study, we included adalimumab treated IBD patients. All patients were invited to receive an ENC. Patients who declined or did not complete the registration for an ENC served as controls. Primary endpoint was whether an ENC increased adherence, calculated from pharmacy refills as proportion of days covered (PDC). Secondary endpoints were clinical outcomes, including loss-of-response, identification of predictors of adherence and correlation between different modalities for measuring adherence. Loss-of-response was defined as a disease flare, dose-escalation or IBD-related hospitalization or surgery. Results: The pharmacies’ records identified 198 eligible patients, of whom 32 were excluded. The ENC was supplied to 69 patients, the remaining 97 patient formed the control group. Median baseline PDC (98.4% vs. 96.1%, p = 0.047) and the proportion of adherent (PDC ≥ 86%) patients (87.0% vs. 74.2%, p = 0.045) was higher for the ENC group. The ENC did not improve the adherence of patients during follow-up (odds ratio 1.26, 95% CI 0.55–2.86). During follow-up, five (7.2%) patients in the ENC group and 13 (13.4%) in the control group discontinued adalimumab (log-rank p = 0.22). Loss-of-response occurred in 12 (17.4%) and 14 (14.4%) patients, respectively (log-rank p = 0.66). Conclusions: Our results show no beneficial effect of a reminder-based intervention on adherence or treatment outcomes.

Original languageEnglish
Pages (from-to)1477-1487
Number of pages11
JournalDigestive Diseases and Sciences
Issue number5
Publication statusPublished - May 2021


  • Adalimumab
  • Anti-TNF
  • Crohn’s disease
  • Inflammatory bowel disease
  • Medication adherence
  • Ulcerative colitis


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