The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis

Objective: We conducted a systematic review to assess antiepileptic drug (AED) adherence rates, and to identify the characteristics associated with nonadherence in children.

Methods: 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.

Results: 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.

Conclusions: 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.