Yang Chunsong, Hao Zilong, Yu Dan, Xu Qunfen, Zhang Lingli
Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Sichuan University. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Epilepsy Res. 2018 May;142:88-99. doi: 10.1016/j.eplepsyres.2018.03.018. Epub 2018 Mar 27.
We conducted a systematic review to assess antiepileptic drug (AED) adherence rates, and to identify the characteristics associated with nonadherence in children.
We searched PubMed, EMBASE, and the Cochrane Library from inception to June 2017. Observational studies addressing medication adherence or examining factors influencing AED adherence were included.
We included 22 studies, involving 3955 participants. The general quality of included studies were rated as high quality. Adherence rates were reported in 18 studies, varying between 22.1% and 96.5%. Meta analysis of 13 studies (n = 2051) revealed a pooled adherence rate assessed by objective methods of 58% (95% CI [0.46, 0.74]). Meta analysis of nine studies (n = 1217) revealed a pooled adherence rate assessed by subjective Methods of 73%, (95% CI [0.63, 0.85]). Family support, smaller family size, stable parental marriage status, support from healthcare providers and higher family socioeconomic status were associated with better medication adherence. However, contradictory results were found regarding the effects of age, the frequency of seizure, type of seizures, type of medication and the number of administered drugs.
Adherence to AEDs is challenging for pediatric patients with epilepsy. Few factors which influence adherence can be drawn because of differing variables and results. Future prospective research should be designed with longer study periods and larger samples in naturalistic settings.
我们进行了一项系统评价，以评估抗癫痫药物（AED）的依从率，并确定与儿童不依从相关的特征。
我们检索了从创刊至2017年6月的PubMed、EMBASE和Cochrane图书馆。纳入了涉及药物依从性或研究影响AED依从性因素的观察性研究。
我们纳入了22项研究，涉及3955名参与者。纳入研究的总体质量被评为高质量。18项研究报告了依从率，在22.1%至96.5%之间。对13项研究（n = 2051）的荟萃分析显示，通过客观方法评估的合并依从率为58%（95%CI[0.46, 0.74]）。对9项研究（n = 1217）的荟萃分析显示，通过主观方法评估的合并依从率为73%（95%CI[0.63, 0.85]）。家庭支持、家庭规模较小、父母婚姻状况稳定、医疗保健提供者的支持以及较高的家庭社会经济地位与更好的药物依从性相关。然而，在年龄、癫痫发作频率、癫痫发作类型、药物类型和给药数量的影响方面发现了相互矛盾的结果。
对于癫痫患儿来说，坚持服用AED具有挑战性。由于变量和结果不同，几乎没有可以得出的影响依从性的因素。未来的前瞻性研究应设计更长的研究周期和更大的自然环境样本。
