Patterns of Nonadherence to Antiepileptic Drug Therapy in Children With Newly Diagnosed Epilepsy

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 (χ42=19.3 [n = 115]; P < .001; partial r2 = 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.

Trajectories of Diabetes Medication Adherence and Hospitalization Risk: A Retrospective Cohort Study in a Large State Medicaid Program

“…56 Group-based trajectory models are novel methods that are increasingly applied for examining dynamic adherence patterns. [13][14][15][16] To our knowledge, our study provides some of the first data supporting the predictive validity of adherence trajectories with regard to clinical outcomes in diabetes. Consistent with the findings from Franklin and colleagues, 15,19 our study showed that longitudinal non-adherence patterns were highly variable, with improved prediction performance for clinical outcomes.…”

“…All analyses were performed using Stata ® 13 (StataCorp LP, College Station, TX) and the TRAJ procedure for trajectory models (www.andrew.cmu.edu/user/bjones). 13,14,34 …”

“…[13][14][15][16] In prior work, trajectory models have been applied to statin adherence, demonstrating variability in adherence patterns over time and an association with cardiovascular events. 17 However, no studies have examined the association between adherence trajectories for oral hypoglycemics and clinical outcomes in diabetes, or compared their predictive performance to traditional adherence metrics.…”

“…In this study, we used group-based trajectory models to identify distinct patterns of oral hypoglycemic refills over time in a large state Medicaid program. [13][14][15][16] We examined the association between these trajectories, as opposed to traditional dichotomous adherence measures (i.e., annual PDC ≥80 vs. <80 %), and subsequent diabetes-related and all-cause hospitalizations or emergency department (ED) visits. Finally, we compared prediction performance using adherence trajectories versus dichotomous measures.…”

Children’s Experiences of Epilepsy: A Systematic Review of Qualitative Studies

“…It is estimated that 38% to 50% of children are nonadherent to their antiepileptic medication within the first 6 months of initiating therapy. 62,63 This may be due to their desire to appear and feel normal, the unrelenting side effects of medication, and disempowerment. Treatment failure also can result in patients losing confidence in traditional health care and disengaging from the system.…”