Bulaj Grzegorz, Clark Jacqueline, Ebrahimi Maryam, Bald Elizabeth
Department of Medicinal Chemistry, Skaggs Pharmacy Institute, University of Utah, Salt Lake City, UT, United States.
College of Pharmacy, University of Utah, Salt Lake City, UT, United States.
Front Pharmacol. 2021 Apr 23;12:612602. doi: 10.3389/fphar.2021.612602. eCollection 2021.
To improve long-term outcomes of therapies for chronic diseases, health promotion and lifestyle modifications are the most promising and sustainable strategies. In addition, advances in digital technologies provide new opportunities to address limitations of drug-based treatments, such as medication non-adherence, adverse effects, toxicity, drug resistance, drug shortages, affordability, and accessibility. Pharmaceutical drugs and biologics can be combined with digital health technologies, including mobile medical apps (digital therapeutics), which offer additional clinical benefits and cost-effectiveness. Promises of drug+digital combination therapies are recognized by pharmaceutical and digital health companies, opening opportunities for integrating pharmacotherapies with non-pharmacological interventions (metapharmacology). Herein we present unique features of digital health technologies which can deliver personalized self-care modalities such as breathing exercises, mindfulness meditation, yoga, physical activity, adequate sleep, listening to preferred music, forgiveness and gratitude. Clinical studies reveal how aforementioned complimentary practices may support treatments of epilepsy, chronic pain, depression, cancer, and other chronic diseases. This article also describes how digital therapies delivering "medicinal" self-care and other non-pharmacological interventions can also be personalized by accounting for: 1) genetic risks for comorbidities, 2) adverse childhood experiences, 3) increased risks for viral infections such as seasonal influenza, or COVID-19, and 4) just-in-time stressful and traumatic circumstances. Development and implementation of personalized pharmacological-behavioral combination therapies (precision metapharmacology) require aligning priorities of key stakeholders including patients, research communities, healthcare industry, regulatory and funding agencies. In conclusion, digital technologies enable integration of pharmacotherapies with self-care, lifestyle interventions and patient empowerment, while concurrently advancing patient-centered care, integrative medicine and digital health ecosystems.
为改善慢性病治疗的长期效果，健康促进和生活方式改变是最有前景且可持续的策略。此外，数字技术的进步为解决基于药物治疗的局限性提供了新机会，如药物不依从、不良反应、毒性、耐药性、药物短缺、可负担性和可及性。药物和生物制品可与数字健康技术相结合，包括移动医疗应用程序（数字疗法），其具有额外的临床益处和成本效益。药物与数字结合疗法的前景得到了制药和数字健康公司的认可，为将药物治疗与非药物干预（元药理学）整合创造了机会。在此，我们介绍数字健康技术的独特特征，这些技术可提供个性化的自我护理方式，如呼吸练习、正念冥想、瑜伽、体育活动、充足睡眠、听喜欢的音乐、宽恕和感恩。临床研究揭示了上述补充性做法如何可能支持癫痫、慢性疼痛、抑郁症、癌症和其他慢性病的治疗。本文还描述了提供“药用”自我护理和其他非药物干预的数字疗法如何也可通过考虑以下因素实现个性化：1）合并症的遗传风险；2）童年不良经历；3）季节性流感或新冠病毒等病毒感染风险增加；4）即时的压力和创伤情况。个性化药物 - 行为结合疗法（精准元药理学）的开发和实施需要使包括患者、研究团体、医疗行业、监管和资助机构在内的关键利益相关者的优先事项保持一致。总之，数字技术能够将药物治疗与自我护理、生活方式干预和患者赋权相结合，同时推进以患者为中心的护理、整合医学和数字健康生态系统。
