Nonadherence to antiepileptic medication and associated factors among persons with epilepsy in India: A systematic review and meta-analysis

IF 2 4区医学 Q3 CLINICAL NEUROLOGY Epilepsy Research Pub Date : 2024-04-03 DOI:10.1016/j.eplepsyres.2024.107358

Aditya Pratap Singh, Vaibhav Chaudhary, Sweta Kumari, Deepali Dhir, Varsha Devi, Biplab Pal

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Abstract

Background

Nonadherence to antiepileptic drugs (AEDs) is a prevalent issue in India, contributing to suboptimal seizure control, higher morbidity and mortality, increased hospitalization rates, and a substantial effect on the overall quality of life for individuals with epilepsy.

Objectives

This study aimed to measure the prevalence of medication adherence among individuals with epilepsy in India and to identify factors associated with nonadherence.

Methods

Following PRISMA guidelines, we searched PubMed, Scopus, Embase, and Google Scholar for studies on AED adherence in India. Quality assessment employed Newcastle Ottawa Scale adapted for cross-sectional studies. Pooled prevalence was ascertained using a random-effects model in R software (version 4.2.2), with a 95% confidence interval. Heterogeneity was estimated with the I² statistic, and publication bias was appraised via a funnel plot. Subgroup analyses, based on study region and adherence measurement tool, were done to investigate heterogeneity.

Results

Nine cross-sectional studies with 1772 participants were analyzed. The pooled prevalence of adherence to AEDs in India stood at 49.9% (95% CI: 39.8%-60.1%). Subgroup analyses showed comparable adherence rates in the South (50.9%) and North (46.5%) regions of India. However, adherence rates varied substantially based on the measurement tool: Morisky Medication Adherence Scale-4 (MMAS-4) reported 71.3%, MMAS-8 indicated 45.9%, and Morisky Green Levine (MGL) adherence scale exhibited 42.0%. Factors contributing to non-adherence to antiepileptic therapies involved poor socioeconomic status, lower education levels, polytherapy, drug-related side effects, and substance abuse.

Conclusions

Almost half of persons with epilepsy in India were non-adherent to their AEDs. This underscores the importance for healthcare professionals to pay greater attention to improving the adherence rate to AEDs within the healthcare service.

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印度癫痫患者不坚持服用抗癫痫药物及相关因素：系统回顾和荟萃分析

背景在印度，不坚持服用抗癫痫药物（AEDs）是一个普遍存在的问题，它导致癫痫发作控制不理想、发病率和死亡率升高、住院率增加，并严重影响了癫痫患者的整体生活质量。本研究旨在测量印度癫痫患者的服药依从性，并确定与不依从性相关的因素。方法按照 PRISMA 指南，我们检索了 PubMed、Scopus、Embase 和 Google Scholar，以寻找印度 AED 依从性方面的研究。质量评估采用了针对横断面研究改编的纽卡斯尔-渥太华量表。使用 R 软件（4.2.2 版）中的随机效应模型确定了汇总患病率，并得出了 95% 的置信区间。异质性通过 I2 统计量进行估计，发表偏倚通过漏斗图进行评估。根据研究地区和依从性测量工具进行了分组分析，以调查异质性。在印度，AEDs 的总体依从率为 49.9%（95% CI：39.8%-60.1%）。亚组分析显示，印度南部地区（50.9%）和北部地区（46.5%）的依从率相当。然而，根据测量工具的不同，依从率也有很大差异：莫里斯基用药依从性量表-4（MMAS-4）显示为 71.3%，MMAS-8 显示为 45.9%，莫里斯基格林莱文（MGL）依从性量表显示为 42.0%。导致不坚持抗癫痫治疗的因素包括社会经济地位低下、教育水平较低、多重治疗、与药物有关的副作用以及药物滥用。这突出表明，医疗保健专业人员必须更加重视提高医疗保健服务中的AED依从率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epilepsy Research 医学-临床神经学

CiteScore

0.10

自引率

4.50%

发文量

143

审稿时长

62 days

期刊介绍： Epilepsy Research provides for publication of high quality articles in both basic and clinical epilepsy research, with a special emphasis on translational research that ultimately relates to epilepsy as a human condition. The journal is intended to provide a forum for reporting the best and most rigorous epilepsy research from all disciplines ranging from biophysics and molecular biology to epidemiological and psychosocial research. As such the journal will publish original papers relevant to epilepsy from any scientific discipline and also studies of a multidisciplinary nature. Clinical and experimental research papers adopting fresh conceptual approaches to the study of epilepsy and its treatment are encouraged. The overriding criteria for publication are novelty, significant clinical or experimental relevance, and interest to a multidisciplinary audience in the broad arena of epilepsy. Review articles focused on any topic of epilepsy research will also be considered, but only if they present an exceptionally clear synthesis of current knowledge and future directions of a research area, based on a critical assessment of the available data or on hypotheses that are likely to stimulate more critical thinking and further advances in an area of epilepsy research.