Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder - a systematic literature review.
Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder - a systematic literature review.
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DOI：
10.2147/ndt.s65721
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发表时间：
2014
影响因子：
3.2
通讯作者：
Xie J
中科院分区：
文献类型：
--
作者：
Gajria K;Lu M;Sikirica V;Greven P;Zhong Y;Qin P;Xie J
未经治疗的注意力缺陷/多动障碍(ADHD)可能会给患者带来严重的社会、经济和情感方面的不良后果。由于治疗依从性低和停药，当前药物治疗的有效性通常会降低。这篇系统的文献综述分析了有关ADHD停药的知识现状，重点放在：1)患者坚持的程度；2)坚持治疗；3)患者停止治疗的潜在原因，以及不同患者亚组之间的停用率和原因有何不同。我们选择了从1990年到2013年发表的91项原创性研究(67项有持续/停止结果，26项有坚持结果，41项有停止、改变或不坚持的原因)和36项关于ADHD药物停止的专家意见综述。在12个月的随访期内，以治疗持续时间衡量，兴奋剂的治疗持久性，儿童和青少年平均为136天，成人为230天。由于大量研究的异质性，跨年龄或药物类型亚组的比较通常是不确定的；然而，长效制剂和苯丙胺与短效制剂和苯乙酸甲酯相比，与更长的治疗持续时间有关。用来衡量服药依从性的药物拥有率，在12个月期间，所有年龄组和药物类别的持药率为0.7。在所有研究中，不良反应是最常被引用的停药原因。最初的研究报告说，缺乏症状控制是常见的停药原因，其次是服药不便、与ADHD药物相关的社会耻辱以及患者的态度。综上所述，尽管在依从性和持久性的测量上缺乏一致性，这些发现表明ADHD患者的药物依从性和持久性普遍较差。临床医生也许能够通过教育护理人员和患者了解治疗目标，给予长效药物，并对患者进行随访，以验证药物是否仍然有效和耐受性良好，从而帮助提高对ADHD治疗的依从性和持久性。
Untreated attention-deficit/hyperactivity disorder (ADHD) can lead to substantial adverse social, economic, and emotional outcomes for patients. The effectiveness of current pharmacologic treatments is often reduced, due to low treatment adherence and medication discontinuation. This current systematic literature review analyzes the current state of knowledge surrounding ADHD medication discontinuation, focusing on: 1) the extent of patient persistence; 2) adherence; and 3) the underlying reasons for patients’ treatment discontinuation and how discontinuation rates and reasons vary across patient subgroups. We selected 91 original studies (67 with persistence/discontinuation results, 26 with adherence results, and 41 with reasons for discontinuation, switching, or nonadherence) and 36 expert opinion reviews on ADHD medication discontinuation, published from 1990 to 2013. Treatment persistence on stimulants, measured by treatment duration during the 12-month follow-up periods, averaged 136 days for children and adolescents and 230 days for adults. Owing to substantial study heterogeneity, comparisons across age or medication type subgroups were generally inconclusive; however, long-acting formulations and amphetamines were associated with longer treatment duration than short-acting formulations and methylphenidates. The medication possession ratio, used to measure adherence, was <0.7 for all age groups and medication classes during a 12-month period. Adverse effects were the most commonly cited reason for discontinuation in all studies. Original research studies reported the lack of symptom control as a common discontinuation reason, followed by dosing inconvenience, social stigma associated with ADHD medication, and the patient’s attitude. In summary, although there was a lack of consistency in the measurement of adherence and persistence, these findings indicate that drug adherence and persistence are generally poor among patients with ADHD. Clinicians may be able to help improve adherence and persistence to ADHD treatment by educating caregivers and patients on treatment goals, administering long-acting medications, and following-up with patients to verify if medication is still effective and well-tolerated.