Remote monitoring to improve engagement for patients with inflammatory bowel disease: a randomized clinical trial.

Background: Biologic therapy has improved care for patients with inflammatory bowel disease (IBD), but adherence is often suboptimal, and a gap in care is lack of engagement between visits. We evaluated the effect of a behaviorally-informed remote text monitoring program on outcomes and adherence among patients with IBD. Methods: Adults with IBD and receiving biologics through home health or self-injection were individually randomized 1:1 to control (usual care) or intervention (remote monitoring), stratified by medication type (home infusion vs. injection). The 4-month intervention included the following components via text message: (1) biologic dose reminders, (2) medication adherence check-ins after each dose, (3) weekly symptom check-ins with escalation to the patient's care team if above threshold, and (4) feedback to an identified support partner (when applicable). The primary outcome was change in quality of life via the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Results: 150 patients were enrolled; 148 completed the study, and 144 were analyzed for the survey outcomes (73 control, 71 intervention). The mean age was 38.9, 52.7% were female, and 81.1% were White. No significant differences were found between arms for the change in median score from baseline to end of study for the SIBDQ, MARS-5, or patient satisfaction surveys. Medication adherence remained high across both arms, and there was no significant difference in the proportion of days covered for infusion or injection between arms. Conclusions: Remote monitoring was feasible with high patient satisfaction, but there was no improvement in quality of life or medication adherence. Trial Registration: clinicaltrials.gov NCT04388865.