Medication adherence among pediatric patients with sickle cell disease: a systematic review
Meyers Primary Care Institute
Adolescent; Anemia, Sickle Cell; *Antibiotic Prophylaxis; Child; Drug Monitoring; Drug Substitution; Humans; Hydroxyurea; Iron Chelating Agents; Medication Adherence; Patient Education as Topic; Penicillins; Treatment Outcome; Young Adult
Hematology | Hemic and Lymphatic Diseases | Pediatrics
OBJECTIVES: Describe rates of adherence for sickle cell disease (SCD) medications, identify patient and medication characteristics associated with nonadherence, and determine the effect of nonadherence and moderate adherence (defined as taking 60%-80% of doses) on clinical outcomes.
METHODS: In February 2012 we systematically searched 6 databases for peer-reviewed articles published after 1940. We identified articles evaluating medication adherence among patients < 25 years old with SCD. Two authors reviewed each article to determine whether it should be included. Two authors extracted data, including medication studied, adherence measures used, rates of adherence, and barriers to adherence.
RESULTS: Of 24 articles in the final review, 23 focused on 1 medication type: antibiotic prophylaxis (13 articles), iron chelation (5 articles), or hydroxyurea (5 articles). Adherence rates ranged from 16% to 89%; most reported moderate adherence. Medication factors contributed to adherence. For example, prophylactic antibiotic adherence was better with intramuscular than oral administration. Barriers included fear of side effects, incorrect dosing, and forgetting. Nonadherence was associated with more vaso-occlusive crises and hospitalizations. The limited data available on moderate adherence to iron chelation and hydroxyurea indicates some clinical benefit.
CONCLUSIONS: Moderate adherence is typical among pediatric patients with SCD. Multicomponent interventions are needed to optimally deliver life-changing medications to these children and should include routine monitoring of adherence, support to prevent mistakes, and education to improve understanding of medication risks and benefits.
DOI of Published Version
Pediatrics. 2014 Dec;134(6):1175-83. doi: 10.1542/peds.2014-0177. Epub 2014 Nov 17. Link to article on publisher's site
Walsh KE, Cutrona SL, Kavanagh PL, Crosby LE, Malone C, Lobner K, Bundy DG. (2014). Medication adherence among pediatric patients with sickle cell disease: a systematic review. Meyers Primary Care Institute Publications. https://doi.org/10.1542/peds.2014-0177. Retrieved from https://escholarship.umassmed.edu/meyers_pp/722