Nonadherence to epilepsy medication triples risk of death

Medical Tribune August 2008 SFVII
David Brill

Patients who do not take their epilepsy medications have a threefold higher risk of death, a recent study has shown.

Researchers from the US studied health insurance claims data from 33,658 people over nine years and divided them into quarterly periods defined as either adherent or nonadherent to medication.

They found that the hazard ratio for mortality during nonadherent quarters was 3.32 (95 percent CI 3.11 – 3.54). These periods were also associated with significantly more emergency department visits, hospitalizations and fractures.

“These findings suggest that nonadherence to antiepileptic drugs can have serious or fatal consequences for patients with epilepsy,” the researchers wrote in Neurology.

They also report that nonadherence was more common among males, patients aged over 65, and African Americans.

Lead author Professor Edward Faught, who is director of the University of Alabama Epilepsy Center, said that doctors should educate patients about the need to take their medications but should be careful not to frighten them excessively.

“It might be counterproductive to be blunt and say ‘if you don’t take your medications you may die,’ but I think it certainly is appropriate for physicians to tell patients that there’s good evidence that serious injuries and hospitalizations, which could result in permanent or fatal results, are known to occur if medications are not taken regularly,” he said.

Faught added that primary care physicians are well placed to discuss medication adherence with their patients, as they typically see them more often than neurologists and may have a better personal rapport.

“It’s important once one initiates a dialogue with the patients about adherence to go further and find out what the problems are,” he said.

“Do they think that it’s not necessary – that they can take it just occasionally and they’ll be fine? Is the medication causing side effects? Is it an economic issue? Or is it simply a problem with the daily schedule?”

The research was based on Medicaid data from Florida, Iowa and New Jersey, compiled between January 1997 and June 2006.

One limitation to the study is that the database does not provide information on the specific causes of death and it cannot be proven that epilepsy was responsible, Faught said.

Dr. Andrew Pan, a consultant neurologist and epileptologist at Mount Elizabeth Medical Centre, said that the same principle applies to the increased incidences of hospitalization and fractures, which were not necessarily caused by epilepsy.

He added that the findings may not be applicable to the general population as patients on Medicaid are likely to be from a lower socioeconomic group.

“Patient compliance to antiepileptic drugs should be routinely checked, especially if seizure control does not appear satisfactory,” Pan concluded.

“It is important that the patient feels that the doctor is working with them to help them with their quest for seizure control.”