Originally published in MedPage Today
by Todd Neale, MedPage Today Staff Writer
Here’s a case where texting may actually improve a teenager’s health: Text message reminders appear to be effective in getting young liver transplant patients to take their immunosuppressive medications, a small study showed.
In 41 patients with a median age of 15, there was a significant improvement in medication compliance after a year of receiving the reminders (P<0.005), Tamir Miloh, MD, of Mount Sinai Hospital in New York City, and colleagues reported online in Pediatrics.
This was accompanied by a drop in the number of histologically proven acute cellular rejection episodes, from 12 in the year before the study to two after one year of receiving the reminders (P=0.02).
The findings were originally reported earlier this year at Digestive Disease Week in Chicago. (See DDW: Texting Teens May Improve Liver Transplant Outcomes)
“The results of this pilot study are encouraging,” the researchers said. “However, larger, randomized controlled studies are needed to establish the efﬁcacy of text messaging in improving medication adherence.”
Nonadherence with immunosuppressive medications, which increases morbidity and mortality after transplant, is more common in younger patients, they said. Noncompliance has been noted in up to 40% of adolescent transplant recipients.
The most common reason cited for not taking the drugs is forgetfulness.
Because texting is so popular among the young and similar reminders have improved hemoglobin A1c levels in pediatric patients with type 1 diabetes, Miloh and colleagues designed this pilot study to see whether text messages could be used to improve compliance in recipients of liver transplants.
Of the patients included in the study, 78% self-administered their medications. The remainder received them from a caregiver.
Medications included tacrolimus (Prograf) and/or sirolimus (Rapamune).
The researchers set up a system that automatically sent text message reminders to either the patient or the caregiver at scheduled times after a healthcare worker logged on.
The medication was considered administered when the patient or caregiver replied to the text message. If no response was received after a certain period of time, another text message was sent to the caregiver.
The standard deviation of serum tacrolimus levels between two measurements was used as a proxy for adherence, with greater variation indicating lower compliance.
In the year before the study, the mean standard deviation of serum tacrolimus concentration was 3.46 µg/L. A mean of 13 months after the text message reminders began, the mean standard deviation dropped to 1.37 µg/L (P<0.005).
The number of patients with a standard deviation greater than 2.5 µg/L, which is associated with rejection episodes, decreased from 24 to six, although the difference did not reach statistical significance (P=0.19).
During the study, 41% of the patients dropped out after a mean of four months.
Nevertheless, at the one-year follow-up, both patients who completed the study and who dropped out showed similar reductions in the mean standard deviation of serum tacrolimus concentration.
“This might be explained by the fact that adherence was improved during the time of participation in the study, and this behavior was learned and continued even after cessation of participation,” the researchers said.
The results were not affected by the number of immunosuppressive medications taken or by the means of administration.
The authors acknowledged that the study was limited by selection bias, the exclusion of patients who did not have cell phones, and the lack of randomization or a control group.