Increasing adherence to treatment in epilepsy: what do the strongest trials show?

Patient non-adherence to prescribed anti-epileptic drugs (AEDs) remains a challenge to successful treatment of patients with epilepsy. However, the literature on epilepsy does not document a comprehensive review of interventions to improve adherence as a means to improve clinical outcomes. This study systematically reviews existing literature on interventions to enhance AED adherence and clinical outcomes, and the measures of adherence included in these studies. We selected randomized controlled trials (RCTs) of interventions to enhance adherence with AEDs, which also measured clinical outcomes, with at least 80% follow-up of participants for at least 6 months, from a comprehensive Cochrane review of adherence interventions for medications, complete to January 2013, and updated searches for additional AED studies in multiple bibliographic databases to January 2016. Two review authors independently extracted all data and a third author resolved disagreements. The present update included one trial from the Cochrane review and three RCTs published since, bringing the total number of RCTs on this topic to four. Two types of intervention were tested: educational (e.g., providing information to the patient or carer about treatment characteristics, duration, dosage regime, and how to use the AED) and behavioral (activity in order to remind the patient to take a medicine). Methods of measuring adherence included a combination of direct (plasma AED levels) and indirect measures (prescription refill frequency and appointment keeping) or use alone of self-report adherence on standardized scales. Despite the importance of the problem, evidence is limited concerning enhancement of adherence among people with epilepsy. However, the trials available to date show that medication adherence in epilepsy can be improved, leading to better seizure control.