Background

Poor adherence to oral antipsychotics is common in patients with schizophrenia; nonetheless, there has been no systematic review or meta-analysis on medication adherence measured by electronic adherence monitoring (EAM), considered by many as the ‘gold standard’ assessment.

Methods

We systematically searched MEDLINE and Embase to identify studies investigating adherence to oral antipsychotics using EAM in patients with schizophrenia spectrum disorder. There were no exclusion criteria. We looked at the methodology in each study and defined which type of adherence was used in the study. Data on medication adherence, definition of satisfactory adherence (i.e., the threshold set in terms of the percentage of times medication was taken as prescribed), and factors associated with adherence were extracted for the included studies. Further, data on the rates of medication adherence were quantitatively synthesized.

Results

A total of 19 studies involving 2184 patients were included. EAM-measured medication adherence was classified into three outcome types: taking adherence, regimen adherence, and timing adherence. The meta-analysis yielded oral antipsychotic adherence rates (defined as a continuous variable) of 71.1% for taking adherence [from seven studies, n = 256, 95% confidence interval (CI) 58.0–84.1], 70.0% for regimen adherence (from five studies, n = 174, 95% CI = 63.6–76.4), and 64.9% for timing adherence (from four studies, n = 212, 95% CI 53.2–76.6), respectively. The proportions of patients with oral antipsychotic adherence, when defined as a dichotomous variable, ranged from 50 to 78.3% for the 70% threshold for satisfactory adherence, 29.8–75.7% for the 75% threshold, and 47.8–75.7% for the 80% threshold. Factors associated with poor medication adherence were greater symptom severity, more frequent dosing regimen, poorer insight, and more negative drug attitude.

Conclusions

Oral antipsychotic adherence rates in schizophrenia, defined as a continuous variable and measured by EAM, were in the range of 70%, lower than the 80% threshold used widely to define satisfactory adherence.

中文翻译：

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通过电子依从性监测测量精神分裂症患者对口服抗精神病药的依从性：系统评价和荟萃分析。

背景

精神分裂症患者对口服抗精神病药依从性差很常见；尽管如此，还没有对通过电子依从性监测 (EAM) 测量的药物依从性进行系统评价或荟萃分析，被许多人视为“金标准”评估。

方法

我们系统地检索了 MEDLINE 和 Embase，以确定调查精神分裂症谱系障碍患者使用 EAM 口服抗精神病药依从性的研究。没有排除标准。我们查看了每项研究中的方法，并定义了研究中使用的依从性类型。为纳入的研究提取了关于药物依从性、满意依从性的定义（即根据规定服用药物的次数百分比设置的阈值）以及与依从性相关的因素的数据。此外，对药物依从率的数据进行了定量合成。

结果

共纳入 19 项研究，涉及 2184 名患者。EAM 测量的药物依从性分为三种结果类型：服用依从性、方案依从性和时间依从性。荟萃分析得出的口服抗精神病药物依从率（定义为连续变量）为 71.1% [来自七项研究，n  = 256，95% 置信区间 (CI) 58.0–84.1]，70.0% 的方案依从性（来自五项研究，n  = 174，95% CI = 63.6–76.4），时间依从性为 64.9%（来自四项研究，n = 212, 95% CI 53.2–76.6)，分别。当被定义为二分变量时，口服抗精神病药依从性患者的比例范围为 50% 至 78.3% 的满意依从性阈值、29.8-75.7% 的 75% 阈值和 47.8-75.7% 的 80%临界点。与药物依从性差相关的因素包括症状更严重、更频繁的给药方案、更差的洞察力和更消极的药物态度。

结论

精神分裂症的口服抗精神病药依从率（定义为连续变量并由 EAM 测量）在 70% 的范围内，低于广泛用于定义满意依从性的 80% 阈值。