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. 2011 Apr 27;305(16):1669-76.
doi: 10.1001/jama.2011.506.

Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy

Avani C Modi  1 , Joseph R Rausch, Tracy A Glauser
Affiliations

Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy

Avani C Modi et al. JAMA. .

Abstract

Context: Because of epilepsy's common occurrence, the narrow therapeutic and safety margins of antiepileptic medications, and the recognized complications of medication nonadherence in adults with epilepsy, identifying the rates, patterns, and predictors of nonadherence in children with epilepsy is imperative. The onset and evolution of antiepileptic drug nonadherence in children with newly diagnosed epilepsy remains unknown.

Objectives: To identify and characterize trajectories of adherence in children with newly diagnosed epilepsy over the first 6 months of therapy and to determine sociodemographic and epilepsy-specific predictors of adherence trajectories.

Design, setting, and patients: Prospective, longitudinal observational study of antiepileptic drug adherence in a consecutive cohort of 124 children (2-12 years old) with newly diagnosed epilepsy at Cincinnati Children's Hospital Medical Center. Patients were recruited from April 2006 through March 2009, and final data collection occurred in September 2009.

Main outcome measure: Objective adherence measured using electronic monitors.

Results: Fifty-eight percent of children with newly diagnosed epilepsy demonstrated persistent nonadherence during the first 6 months of therapy. Group-based trajectory models identified 5 differential adherence patterns (Bayesian information criterion = -23611.8): severe early nonadherence (13%; 95% confidence interval [CI], 8%-20%), severe delayed nonadherence (7%; 95% CI, 3%-12%), moderate nonadherence (13%; 95% CI, 8%-20%), mild nonadherence (26%; 95% CI, 19%-34%), and near-perfect adherence (42%; 95% CI, 33%-50%). The adherence pattern of most patients was established by the first month of therapy. Socioeconomic status was the sole predictor of adherence trajectory group status (χ(4)(2) = 19.3 [n = 115]; P < .001; partial r(2) = 0.25), with lower socioeconomic status associated with higher nonadherence.

Conclusion: Five trajectory patterns were identified that captured the spectrum of nonadherence to antiepileptic drugs among children with newly diagnosed epilepsy; the patterns were significantly associated with socioeconomic status.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Modi reports that she has been a consultant for Novartis Pharmaceuticals Inc, which has an interest in antiepileptic drugs. Dr Glauser reports that he is an advisor to, a speaker for, and has received research grants from companies with interests in antiepileptic drugs, including ucb Pharma, Eisai, Upsher-Smith, Lundbeck, Sunovion, Supernus, and Questcor. No other disclosures were reported.

Figures

Figure
Figure
Six-Month Adherence Trajectories of Children With New-Onset Epilepsy Smooth curves represent model-based group trajectories.
See this image and copyright information in PMC

Comment in

References

    1. Modi AC, Guilfoyle SM. Adherence to antiepileptic drug therapy across the developmental life-span. In: Pinikahana J, Walker C, editors. Society, Behaviour and Epilepsy. New York, NY: Nova Science Publishers Inc; 2011. pp. 175–205.
    1. Modi AC, Cassedy AE, Quittner AL, et al. Trajectories of adherence to airway clearance therapy for patients with cystic fibrosis. J Pediatr Psychol. 2010;35(9):1028–1037. - PubMed
    1. Glass TR, Battegay M, Cavassini M, et al. Longitudinal analysis of patterns and predictors of changes in self-reported adherence to antiretroviral therapy: Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2010;54(2):197–203. - PubMed
    1. Bassili A, Omar T, Zaki A, Abdel-Fattah M, Tognoni G. Egyptian-Italian Collaborative Group on Paediatric Chronic Diseases. Pattern of diagnostic and therapeutic care of childhood epilepsy in Alexandria, Egypt. Int J Qual Health Care. 2002;14(4):277–284. - PubMed
    1. Lund L. Anticonvulsant effect of diphenylhydantoin relative to plasma levels: a prospective 3-year study in ambulant patients with generalized epileptic seizures. Arch Neurol. 1974;31(5):289–294. - PubMed

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