Nonadherence to antiseizure medications: what have we learned and what can be done next?

ABSTRACT

Introduction

Nonadherence to antiseizure medications (ASMs) is associated with increased mortality, morbidity, health care utilization, and costs.

Areas covered

This article reviewed 18 randomized controlled trials published between Jan 2010 and Feb 2024 on Medication Adherence Enhancing Intervention (MAEI) for people with epilepsy. The adequacy of reporting intervention development process was assessed using the GUIDance for the rEporting of intervention Development (GUIDED). The adequacy of the intervention description was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. The interventions were categorized as educational (n = 7), behavioral (n = 5), or mixed (n = 6). The impact of MAEIs on adherence is mixed with majority of studies either reporting no difference between intervention and control groups (n = 6) or improvement in the intervention group (n = 7). The shortcomings in the reporting of MAEIs development, MAEIs description, and MAEIs impact measurement were discussed.

Expert opinion

Future research needs to accomplish the following tasks: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design; and 3) increase transparency in reporting all stages of research.

KEYWORDS:

• Medication adherence
• antiseizure medications
• epilepsy
• intervention
• randomized controlled trials
• antiepileptic medication

Article highlights

• The number of published trials on effectiveness and cost-effectiveness of MAEIs in people with epilepsy is limited.

• The effectiveness and cost-effectiveness of MAEIs in people with epilepsy remain unresolved.

• Poor descriptions of MAEIs development process may hinder evaluation, replication and building on research findings as well as implementation in everyday clinical practice.

• There are two research priority areas MAEIs in people with epilepsy: 1) develop and test valid epilepsy-specific self-report measures for assessing adherence; 2) optimize intervention design using available guidelines and frameworks.

• Future research should utilize available recommendations and frameworks for intervention development and reporting.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2024.2349191.

Additional information

Funding

This paper was not funded.