One-month adherence in children with new-onset epilepsy: White-coat compliance does not occur

Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self Management, MLC-3015, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
PEDIATRICS (Impact Factor: 5.3). 05/2008; 121(4):e961-6. DOI: 10.1542/peds.2007-1690
Source: PubMed

ABSTRACT Adherence to antiepileptic drug therapy plays an important role in the effectiveness of pharmacologic treatment of epilepsy. The purpose of this study was to use an objective measure of adherence to (1) document patterns of adherence for the first month of therapy for children with new-onset epilepsy, (2) examine differences in adherence by demographic and epilepsy variables, and (3) determine whether treatment adherence improves for a short time before a clinic visit (eg, "white-coat compliance").
Participants included 35 children with new-onset epilepsy (mean age: 7.2 years; 34% female; 66% white) and their caregivers. Children had a diagnosis of partial (60%), generalized (29%), or unclassified (11%) epilepsy. Adherence to treatment was electronically monitored with Medication Event Monitoring System TrackCap, starting with the first antiepileptic drug dose. Adherence was calculated across a 1-month period and for the 1, 3, and 5 days before and 3 days after the clinic appointment.
Adherence for the first month of treatment in children with new-onset epilepsy was 79.4%. One-month adherence was higher in children of married parents and those with higher socioeconomic status but did not correlate with child's gender, age, epilepsy type, prescribed medication, seizure frequency, or length of time since seizure onset. Adherence across the entire 1-month period was not different from adherence for the 1, 3, or 5 days before or 3 days after the clinic visit.
Poor adherence seen for children with new-onset epilepsy during the first month of antiepileptic drug therapy is a cause for concern. Several demographic variables influence adherence to treatment, whereas the proximity to a clinic visit does not. Additional studies are needed to document whether this trend continues longitudinally and determine the clinical impact of poor adherence.

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    ABSTRACT: Purpose: The objective of this retrospective claims study was to describe antiepileptic drug (AED) treatment patterns and burden of illness in children with epilepsy. Methods: Data were administrative claims from a US commercial health plan. Patients were between 2 and 17 years of age and had one or more pharmacy claims for an oral AED from July 1, 2005, to November 30, 2009. The index date was defined as the first AED claim. Patients had one or more medical claims for epilepsy (ICD-9-CM 345.xx) during the 6-month pre-index period and were continuously enrolled for 12 months post index. Of the 17 AED medications used to identify patients, eleven medication cohorts had more than 100 patients: (1) carbamazepine (CAR); (2) clonazepam; (3) gabapentin (GAB); (4) lamotrigine (LAM); (5) levetiracetam (LEV); (6) oxcarbazepine (OXC); (7) phenobarbital; (8) phenytoin (PHY); (9) topiramate (TOP); (10) valproate (VAL); and (11) zonisamide (ZON). Results: There were 3889 children who met the inclusion criteria. There were some differ-ences in patients across the eleven AED treatment cohorts based on index therapy in age, gender, geographic location, Charlson comorbidity score, AHRQ comorbid conditions, as well as epilepsy-related risk factors and comorbidities. Of the 17 AEDs examined, the most frequently prescribed were OXC (21%) and LEV (19%); the least prescribed AED was GAB (1%). Their respective mean post-index pharmacy and total costs were as follows: OXC, US$2095 and US$5556; LEV, US$3025 and US$9121; and GAB, US$917 and US$1597. The overall post-index mean pharmacy costs were US$2637, and mean total costs were US$6813. Conclusion: Study results demonstrate differences in patient demographic and clinical characteristics across AED medication cohorts. Some cohorts have greater odds of a switch, or augmentation than the reference comparator CAR cohort. Variation was also observed in brand or generic medication use. LAM and TOP had the highest annual pharmacy costs of all the drugs.
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    ABSTRACT: Introduction Epilepsy is one of the neglected and highly stigmatised diseases, yet it is very common affecting about 70 million people worldwide. In Uganda, the estimated prevalence of epilepsy is 13% with about 156 new cases per 100,000 people per year. Adherence to antiepileptic drugs is crucial in achieving seizure control yet in Uganda; there is lack of information on adherence to antiepileptic drugs and the factors that affect this among children. This study was therefore designed to determine the level of adherence to antiepileptic drugs and the factors that are associated with non adherence. Methods In a cross sectional study, 122 children who met the inclusion criteria were enrolled and interviewed using a pretested questionnaire. Assessment of adherence to antiepileptic drugs was done by self report and assay of serum drug levels of the antiepileptic drugs. Focus group discussions were held to further evaluate the factors that affect adherence. Results Age range was 6 months - 16 years, male to female ratio 1.3:1 and majority had generalised seizures 76 (62.3%). Adherence to antiepileptic drugs by self report was 79.5% and 22.1% by drug levels. Majority of the children in both adherent and non adherent groups by self report had inadequate drug doses (95/122). Children were found to be more non-adherent if the caregiver had an occupation (p-value 0.030, 95%CI 1.18-28.78) Conclusion Majority of children had good adherence levels when estimated by self report. The caregiver having an occupation was found to increase the likelihood of non adherence in a child.
    01/2014; 17:44. DOI:10.11604/pamj.2014.17.44.3399