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by Ryan Noble
Last month I had the opportunity to spend the week in the South of France. But instead of catching up on some much needed Vitamin D, I joined other industry experts in the world of Respiratory Drug Delivery (RDD) at the 2017 conference in Nice.
One of the main themes running throughout this year’s event, and generally within the drug/device combination products industry, was connectivity. Connectivity means many things to many people, however, in the world of RDD right now the core issue is ‘adherence’. But how do we define ‘adherence’? There were several perspectives presented including the regulators, payers, pharma companies, healthcare professionals and the patients themselves.
Dr Federico Lavorini of the Careggi University Hospital, Florence, references a paper published by the WHO, which showed that adherence in long term therapies was an issue in 2004 and estimating that the ‘cost’ of non-adherence may run into billions of dollars of wasted medication and hospital admissions. But if I look at the design of devices available on the market I don’t see much change over the last decade. Whilst two generic versions of GSK’s Advair Diskus have recently received Complete Response Letters from the FDA, Dr Lavorini’s presentation highlighted that the Diskus DPI device has several significant observed use errors, including dose dumping. Although pMDIs have been around for over 50 years and are being repurposed in the administration of biologics, pMDIs also have well-documented use errors. Studies have shown that the observed natural operation of a pMDI is to inhale sharply due to the aerosol generated being ballistic - even though the instructions for use state to do so slowly. This was brilliantly depicted by Dr Lavorini in the form of ‘Le Chiffre’ from the ‘James Bond-Casino Royale' film having really poor inhaler technique. How unusual for Hollywood to get it wrong.
So can connectivity help us? There were a number of new designs and products on show that try in one form or another. From apps that can remind us when to take our medication, to integrated device sensors that give the patient feedback on correct use. It raises some questions - will this give us adequate insight into how patients/users truly interact with their devices? Will this information be beneficial in providing evidence of the value proposition for the product? And, will the healthcare professional have to log onto yet another website? An idea that caused a small uproar at the conference.
As I see it, the status of this movement towards connectivity and adherence is one of lots of good ideas and energy, however, there is a need to collectively figure out how to bring it all together for the good of all involved. Improved patient treatment, reduced burden on healthcare providers and true value based healthcare.
At CDP we like to think that the way forward is to start with understanding stakeholder behaviour to inform design decisions, leading to quantified use interaction during the clinical investigation and appropriately selected product connectivity in the commercial space.
To read more on just one solution we are working on please click here to read about our new user insight service that helps gain a deeper understanding of consumer behaviour.
And as for the Vitamin D, I will be back in France this August with the family to catch-up on it!
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