4.6 Review

A systematic review of adherence to iron chelation therapy among children and adolescents with thalassemia

期刊

ANNALS OF MEDICINE
卷 54, 期 1, 页码 326-342

出版社

TAYLOR & FRANCIS LTD
DOI: 10.1080/07853890.2022.2028894

关键词

Thalassaemia; iron chelation therapy; adherence; compliance; interventions; behaviour

资金

  1. National Heart, Lung, and Blood Institute of the National Institutes of Health [K23HL150232]

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This article reviews and analyzes the adherence to iron chelation therapy (ICT) in children and adolescents. The results show that there is a variety of methods to assess adherence, and the adherence rates vary. Limited studies have focused on interventions to improve adherence, with successful interventions emphasizing consistent, long-term engagement with patients.
Introduction Iron chelation therapy (ICT) is essential to prevent complications of iron overload in patients with transfusion-dependent thalassaemia. However, there is currently no standard for how to best measure adherence to ICT, nor what level of adherence necessitates concern for poor outcomes, especially in paediatric patients. The objectives of this review are to identify rates of adherence to ICT, predictors of adherence, methods of measurement, and adherence-related health outcomes in children and adolescents. Methods This review covers the literature published between 1980 and 2020 on ICT in thalassaemia that assessed adherence or compliance. Included studies reflect original research. The preferred reporting items of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting results, and the findings were critically appraised with the Oxford Centre for Evidence-based Medicine criteria. Results Of the 543 articles, 37 met the inclusion criteria. The most common methods of assessing adherence included patient self-report (n = 15/36, 41.7%), and pill count (n = 15/36, 41.7%), followed by subcutaneous medication monitoring (5/36, 13.8%) and prescription refills (n = 4/36, 11.1%). Study sizes ranged from 7 to 1115 participants. Studies reported adherence either in categories with different levels of adherence (n = 29) or quantitatively as a percentage of medication taken out of those prescribed (n = 7). Quantitatively, the percentage of adherence varied from 57% to 98.4% with a median of 89.5%. Five studies focussed on interventions, four of which were designed to improve adherence. Studies varied in sample size and methods of assessment, which prohibited performing a meta-analysis. Conclusions Due to a lack of clinical consensus on how adherence is defined, it is difficult to compare adherence to ICT in different studies. Future studies should be aimed at creating guidelines for assessing adherence and identifying suboptimal adherence. These future efforts will be crucial in informing evidence-based interventions to improve adherence and health outcomes in thalassaemia patients. Key messages Predictive factors associated with ICT adherence in the paediatric population include age, social perception of ICT, social support, and side effects/discomfort. Increased adherence in the paediatric population is associated with decreased serum ferritin and improved cardiac, hepatic, and endocrine outcomes. Inadequate adherence to ICT is associated with increased lifetime health costs. There are few studies that focussed on interventions to increase adherence in the paediatric population, and the studies that do exist all focussed on different types of interventions; successful interventions focussed on consistent, long-term engagement with patients.

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