Understand Effective Strategies for Monitoring Topical Dermatological Agents

In an interview with Pharmacy Times, Matthew Zirwas, MD, discusses the challenges of monitoring medication adherence, particularly with topical treatments such as ruxolitinib (Opzelura; Incyte). He highlights the discrepancy between perceived and actual usage, citing studies that reveal patients often overestimate their compliance. Zirwas also emphasizes the importance of direct questioning and assessing medication usage as effective strategies for gauging adherence.

Pharmacy Times: In your experience, what are the most effective strategies for monitoring adherence to ruxolitinib in the outpatient setting? Are there any tools or technologies you find useful?

Matthew Zirwas, MD: So, one of my favorite dermatologists in the world is a guy named Steve Feldman, MD, PhD, who is at Wake Forest University, and he's done a number of studies where they secretly put little chips in the caps of tubes, and then they see if patients actually use them. And it turns out that patients think they use topicals a lot more than they actually do. So, in one of his studies they looked at using an acne topical medication, and people were supposed to use it once a day for a month. And if they used it for 24 days out of the 30, they were considered compliant. Not a single person was actually compliant whenever they monitored with those little caps. And so really monitoring adherence, other than asking, you know, ‘Hey, are you using it?’ doesn't actually do a whole lot of good.

Monitoring compliance with topicals is extremely difficult, and one of the best ways to do it is really ask them, ‘Well, where are you putting it on?’ And if they say, ‘Well, I'm putting it on my whole face,’ and say, ‘Okay, that should take about a gram a day. You filled your last prescription 2 months ago, so it's been 60 days. You should be out of medication. Are you out of medication?’ And if now they still have, like, a half a tube left, then you know they're not being compliant, right? That's one of the only ways to try and really get at it, because it's not that patients are lying right whenever they say, like, ‘Oh, I use it every day.’ If you hooked them up to a polygraph machine, they totally believe it 100%, they would be off scot-free if they were being prosecuted. But in reality, they didn't use it. They just think they used it. And so, getting at it that way, with how much medication do you have left? That can be one of the ways to help gauge compliance.

Pharmacy Times: Is there anything you would like to add?

Zirwas: The one thing I would say is that the biggest thing that surprised me about Opzelura for atopic dermatitis is the difference it makes in people's lives. It’s even bigger than I would have expected based on, like, it's incredibly effective, but it’s the first drug for atopic dermatitis that has given patients a sense of control over their disease. So, it used to be they had steroids, which they knew would work pretty quick, but they didn't want to use it, or they had nonsteroidal topicals that they knew were going to take a week to start working, and so they were like, ‘Well, my God, if my eczema starts up, you know, Tuesday at work, what am I going to do? I can't wait a week, but I don't want to use that steroid.’ Now that they have the confidence that, ‘Oh, if my eczema starts to flare back up, I got my Opzelura at home. I'll put it on. My eczema will be better in 15 minutes.’ That sense of confidence in being able to manage their atopic dermatitis is one of the biggest factors that was unexpected for me. I knew the drug was particularly effective, but it's even better than you would expect, and it's because it gives patients that sense of confidence.