Central Texas Veterans Health Care System, Temple, TX, USA.
Ann Pharmacother. 2010 Dec;44(12):1896-904. doi: 10.1345/aph.1P385. Epub 2010 Nov 2.
Medication adherence among patients with epilepsy remains a significant challenge, even for patients prescribed newer antiepileptic drugs (AEDs), leading to increased risks of seizures, hospitalizations, and higher treatment costs. Despite substantial research identifying numerous risk factors, the role of specific medications has been neglected.
To analyze adherence to 9 different AEDs in a national clinical sample of elderly patients with new-onset epilepsy.
Patients over age 66 receiving care in the Veterans Health Administration were eligible if they met criteria for new-onset epilepsy with AED monotherapy of at least 3 months. A cross-sectional study design was used to assess adherence as defined by the medication possession ratio (MPR) and a 90-day or longer medication gap. Multivariable logistic regression modeled each dichotomous adherence outcome as a function of clinical and demographic measures.
The sample (N = 6373) was primarily male (98%), white (79%), and exempt from medication copayments due to disability status; nearly 40% had a prior psychiatric or dementia diagnosis. Nearly half of the patients were poorly adherent, with rates ranging from 42% to 63% across AEDs. In multivariable models, patients on phenobarbital, valproate, and gabapentin were significantly less likely to be adherent on both outcomes, while lamotrigine and levetiracetam were positively associated with adherence per the MPR.
Adherence difficulty in this elderly cohort is attributable to several factors, yet specific AEDs substantially increased this risk. Drugs that produce adverse effects such as cognitive difficulty or weight gain may prove detrimental to maintaining appropriate adherence early in the treatment course. Given comparable efficacy among AEDs, providers should be aware that certain medications impart differential risks of poor adherence in older patients with epilepsy.
即使对于服用新型抗癫痫药物（AED）的患者，癫痫患者的药物依从性仍然是一个重大挑战，这会增加癫痫发作、住院和更高治疗成本的风险。尽管有大量研究确定了许多风险因素，但特定药物的作用却被忽视了。
分析在一个新诊断为癫痫的老年患者的全国临床样本中，对 9 种不同 AED 的依从性。
如果患者符合新诊断为癫痫的标准，且接受 AED 单药治疗至少 3 个月，则符合退伍军人健康管理局的老年患者入选标准。采用横断面研究设计评估药物占有率（MPR）和 90 天或更长时间的药物空白定义的依从性。多变量逻辑回归模型将每个二项式依从性结果作为临床和人口统计学措施的函数进行建模。
该样本（N=6373）主要为男性（98%）、白人（79%），因残疾状况而免于药物共付额；近 40%的患者有先前的精神或痴呆诊断。近一半的患者依从性差，9 种 AED 中的每一种的发生率从 42%到 63%不等。在多变量模型中，服用苯巴比妥、丙戊酸钠和加巴喷丁的患者在两种结果上都不太可能依从，而拉莫三嗪和左乙拉西坦与 MPR 一致，与依从性呈正相关。
在这个老年队列中，依从性困难归因于几个因素，但特定的 AED 极大地增加了这种风险。会导致认知困难或体重增加等不良反应的药物可能会在治疗早期对维持适当的依从性产生不利影响。鉴于 AED 的疗效相当，提供者应意识到，在老年癫痫患者中，某些药物会带来不同的依从性不良风险。
