Accuracy of machine learning-based prediction of medication adherence in clinical research

•Medication non-adherence represents a significant barrier to treatment efficacy.•Data from remote real-time measurements of medication dosing, along with patients’ primary diagnosis, demographics, and prior indication of observed adherence/non-adherence were utilized to accurately predict rates of medication adherence of ≥ 80% across a clinical trial, adherence over the subsequent week, and adherence the subsequent day using machine learning-based classification models.•Real-time measurement of dosing can be utilized to dynamically predict medication adherence with high accuracy, which in-turn allows for proactive clinical intervention to optimize health outcomes. Medication non-adherence represents a significant barrier to treatment efficacy. Remote, real-time measurement of medication dosing can facilitate dynamic prediction of risk for medication non-adherence, which in-turn allows for proactive clinical intervention to optimize health outcomes. We examine the accuracy of dynamic prediction of non-adherence using data from remote real-time measurements of medication dosing. Participants across a large set of clinical trials (n = 4,182) were observed via a smartphone application that video records patients taking their prescribed medication. The patients’ primary diagnosis, demographics, and prior indication of observed adherence/non-adherence were utilized to predict (1) adherence rates ≥ 80% across the clinical trial, (2) adherence ≥ 80% for the subsequent week, and (3) adherence the subsequent day using machine learning-based classification models. Empirically observed adherence was demonstrated to be the strongest predictor of future adherence/non-adherence. Collectively, the classification models accurately predicted adherence across the trial (AUC = 0.83), the subsequent week (AUC = 0.87) and the subsequent day (AUC = 0.87). Real-time measurement of dosing can be utilized to dynamically predict medication adherence with high accuracy.