SciELO - Scientific Electronic Library Online

 
vol.37 número2CUIDADO PERINATAL EM UM ESTADO DO NORDESTE BRASILEIRO: ESTRUTURA, PROCESSOS DE TRABALHO E AVALIAÇÃO DOS COMPONENTES DO ESSENTIAL NEWBORN CARE índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados

Journal

Artigo

Indicadores

Links relacionados

Compartilhar


Revista Paulista de Pediatria

versão impressa ISSN 0103-0582versão On-line ISSN 1984-0462

Rev. paul. pediatr. vol.37 no.2 São Paulo abr./jun. 2019  Epub 19-Jun-2019

http://dx.doi.org/10.1590/1984-0462/;2019;37;2;00019 

Editorial

POOR ADHERENCE TO DRUG TREATMENT IN CHILDREN AND ADOLESCENTS WITH AUTOIMMUNE RHEUMATIC DISEASES

aUniversidade de São Paulo, São Paulo, SP, Brazil.

I read with great interest the study reported by Mioto e Silva et al.1 The investigators developed a relevant self-administered tool to assess adherence to medical and non-medical treatment in pediatric autoimmune chronic rheumatic diseases (PARDs). A pilot study evaluated a Pediatric Rheumatology Adherence Questionnaire, applied to caregivers, in two instances: diagnosis (the first four months of disease) and after six months. The four most important PARDs was included. Poor global adherence, defined as adherence <95%, was observed in 7/33 (21%) patients, poor adherence to medical treatment in 8/33 (24%), and a trend to correlation between socioeconomic factors and poor adherence was evidenced.

There are many factors associated with non/poor adherence to drug treatment in children and adolescents with PARDs, particularly low socioeconomic status, psychological stress of parents/patients, family dysfunction, drug unavailability, insurance type and coverage, unwanted adverse events and concomitant use of more than three different types of drugs daily.2,3,4,5

In addition, non/poor adherence to drug treatment and appointments in PARDs are more relevant issues, particularly in the second decade of life.3,4,5 Indeed, adolescents have a set of biological, psychosocial and brain maturation developments, becoming more independent, with caregiver autonomy, peer connection, beginning of sexual and romantic relationships.3,4 These findings may be delayed, exacerbated or impaired in adolescents with PARDs, contributing to low adherence to the use of immunosuppressive and biologic agents.

A recent web-based survey study evaluated epidemiology and management practices about childhood-onset systemic lupus erythematosus, including reports of 170/288 (59%) Latin American Pediatric Rheumatologists from 16 countries. Non-adherence to medications was the most important issue described by 97% of respondents, in spite of high frequencies of availability of glucorticosteroid, antimalarials and immunosuppressive drugs (>80%).5

Therefore, assessing and preventing low adherence poses a great challenge in clinical practice. Direct and indirect methods may help measure poor treatment adherence and should be regularly evaluated: self-administered questionnaires, structured interviews with patients/parents, electronic monitoring devices, adherence history and measurement of serum/drug metabolite levels.2,4 Specific programs for this purpose should be developed to improve compliance. Behavior and education strategies about the disease and treatments, through constructive dialogue at individual/group level with multidisciplinary teams may help PARDs patients improve adherence.2,4

REFERENCES

1. Miotto e Silva VB, Okamoto KY, Ozaki LS, Len CA, Terreri MT. Early detection of poor adherence to treatment of pediatric rheumatic diseases: Pediatric Rheumatology Adherence Questionnaire (PRAQ) - A pilot study. Rev Paul Pediatr. In press 2019. Epub Mar 18, 2019. [ Links ]

2. Len CA, Miotto e Silva VB, Terreri MT. Importance of adherence in the outcome of juvenile idiopathic arthritis. Curr Rheumatol Rep. 2014;16:410. [ Links ]

3. Silva CA, Terreri MT, Bonfá E, Saad-Magalhães C. Pediatric rheumatic disease patients: time to extend the age limit of adolescence? Adv Rheumatol. 2018;58:30. [ Links ]

4. Silva CA, Aikawa NE, Pereira RM, Campos LM. Management considerations for childhood-onset systemic lupus erythematosus patients and implications on therapy. Expert Rev Clin Immunol. 2016;12:301-13. [ Links ]

5. Ferreira JC, Trindade VC, Espada G, Morel Z, Bonfá E, Magalhães CS, et al. Epidemiology and management practices for childhood-onset systemic lupus erythematosus patients: a survey in Latin America. Clin Rheumatol. 2018;37:3299-307. [ Links ]

Funding

The author has been supported by grants from National Council for Scientific and Technological Development (CNPq; 303422/2015-7 to CAS), São Paulo Research Foundation (FAPESP; 2015/03756-4 to CAS) and by the “Núcleo de Apoio à Pesquisa em ‘Saúde da Criança e do Adolescente’” Research Support Center of University of São Paulo (NAP-CriAd) to CAS.

Received: February 17, 2019

*Corresponding author. E-mail: clovis.silva@hc.fm.usp.br (C.A. Silva).

The authors declare no conflict of interests.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License