How digital therapeutics are changing user behaviours

Where digital therapeutics have proven effective

One of the better-known applications for DTx today is treatment of insomnia, with examples such as Sleep.io and Sleepstation. Both of these services deliver Cognitive Behavioural Therapy (CBT) via an online platform, based on a therapy programme which has long proven clinically effective in the form of a face-to-face therapy. There are a number of advantages to receiving therapy through a digital medium, including a reduction in the burden on healthcare professionals, and the ability for patients to self-refer to gain immediate access. Intriguingly, Sleep.io also claim their product has proven more clinically effective than the equivalent face-to-face treatment.

One of the more fascinating case studies shared at the 2023 Royal Society of Medicine’s “Spotlight on Digital Therapeutics” conference was presented by Dr Hakin Yadi, CEO of Closed Loop Medicine. Whereas the usual DTx format is purely digital, his example paired a digital component with conventional pharmaceuticals for the treatment of hypertension. We all know that any drug usually comes in a handful of fixed doses and a doctor will prescribe the dose most appropriate for a patient’s needs. Dr Yadi explained that the side effects for this particular medication can typically be quite extreme and as a result some patients were crushing their pills to take a custom amount to try to find their optimal dose. This highlighted a clear opportunity for more tailored medication.

As part of a clinical study, Closed Loop provided a DTx to help patients tailor their dose by more scientific means, in other words providing a “technology enhanced drug.” Remarkably, side effects were completely eliminated for patients in this study when their dose was optimised. This, in turn, resulted in a behaviour change among patients who thereafter showed dramatically improved adherence to the treatment.

Why aren’t digital therapeutics already ubiquitous?

Adoption has been one barrier to the emergence of digital health technologies, as can commonly be the case with any new technology. But signs suggest that this is a barrier we are now overcoming, with the recent pandemic being a key contributing factor to this. At the same Royal Society of Medicine conference, Dr John O’Dowd presented his ‘Pathway through Pain’ product, a DTx developed to mitigate back pain. The product was developed almost a decade ago, based on a proven face-to-face programme. O’Dowd explained that when the product was originally released, it proved to be “a complete flop.” However, fast-forward 10 years and despite little development of the product during this time it has now become commonly used. Even more fascinating is that O’Dowd explained this digital version of the therapy is on course to achieve equivalent or better results to in-person therapy in clinical evaluations.

Another barrier for DTx is where the liability lies. In a sea of so many health apps, including but by no means limited to digital therapeutics, how does a GP identify and recommend offerings which are clinically proven and trustworthy? Added to this is the unimaginable complexity of integrating a whole new genre of therapeutics into existing healthcare systems and regulatory landscapes around the globe. There may be plenty of innovations out there, but only a finite few with the appetite and the budget to push them through to market.

Finally, a barrier which is in vogue for almost any area of digital innovation today is data. Medical data is sensitive by nature, and even if a given patient community is willing to share it, the other party must still accept responsibility for storing and managing it. This issue of ownership may never have a simple answer, and the nuances of how it gets addressed will vary on a geographical level. It’s clear however, that any resolution requires a certain degree of trust and transparency between patient and service provider.

What does the future hold for digital therapeutics?

DTx look set for further growth within the areas they have so far proven most successful, these being behavioural and mental health along with diabetes and dietary applications. But other sectors look set for growth too, even including some which might not intuitively lend themselves to DTx. These include musculoskeletal health, oncology, femtech, digestive health and cardiology.

Within this broad range of sectors, we are sure to see a mixture of approaches between pure digital products, connected systems and “technology enhanced drugs”, like the Closed Loop Medicine example. There will also be a need for an evolution within the regulatory landscape to adapt to the demands of software of this nature running across millions of different devices or devices versions, something that will involve work from the Digital Therapeutics Alliance and others. Within the UK, we may also see an increase in the number of DTx products integrated with NHS services, with the help of external bodies like Orcha providing recommendations on which products are clinically proven and trustworthy.

We’ve witnessed great growth in the DTx space in recent years in terms of both uptake, the variety that’s out there and the ever increasing range of applications. Perhaps the most intriguing solutions are those proven to have an even higher efficacy than their traditional counterparts. Any digital therapeutic product, as a piece of software, only truly has the power to change the behaviour of users. That some products have been able to showcase the power to achieve this more effectively than traditional treatments shows the potential of this emerging sector of medicine and the positive patient outcomes this can accelerate.