J Control Release. 2026 Aug 06. pii: S0168-3659(26)00645-0. [Epub ahead of print]
115241
Advanced therapeutics increasingly require precise control over drug transport, barrier penetration, release kinetics, local exposure, and dosing safety to achieve reliable efficacy. However, clinically precise administration often remains dependent on professional operation, which limits the translation of complex therapies into chronic, home-based, or decentralized care. This gap is not simply a problem of patient adherence, but a delivery-science challenge: how to reproduce clinical-grade therapeutic control through systems that can be initiated, maintained, and interpreted outside professional settings. Here, we define integrated drug-device systems (IDDSs) as autonomous therapeutic architectures that embed professional delivery logic into system-controlled platforms. This review reframes these technologies around three engineering pillars: mechanical autonomy, which encodes tissue targeting, barrier bypassing, actuation, and residence into device structures; programmable release, which integrates dosing logic into materials, reservoirs, and responsive architectures to execute predefined or adaptive pharmacokinetic programs; and monitoring-decision integration, which converts administration quality, device performance, and physiological signals into actionable data for feedback-guided management. We further propose a maturity-grading model and an Available-Accessible-Controllable (AAC) framework to evaluate whether integrated drug-device systems can move beyond technical feasibility toward clinically usable, practically accessible, and therapeutically controllable delivery platforms. By organizing autonomous administration, programmable release, and feedback regulation within a unified delivery-science framework, this review provides a roadmap for engineering next-generation drug-device systems that decouple therapeutic precision from professional manual operation and support robust therapeutic control in decentralized environments.
Keywords: Decentralized precision management; Integrated drug–device systems (IDDSs); Mechanical autonomy; Monitoring–decision integration; Programmable drug delivery