Poor Adherence to Drug Treatment in Children and Adolescents With Autoimmune Rheumatic Diseases

Silva, Clóvis A.

doi:10.1590/1984-0462/;2019;37;2;00019

Cited by 6 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…cSLE patients are mainly in the adolescence period [ 20 ]. This transitional phase to adulthood involves several physical and emotional changes [ 37 ], and the impact of this complex disease may affect their self-management and self-esteem [ 174 , 175 ]. In fact, a cSLE study in adolescents and young adults with a semi-structured interview showed that the use of medication served as reminders of their illness and made them feel abnormal [ 176 ].…”

Section: Drug Adherence For Adolescentsmentioning

confidence: 99%

“…There are factors associated with nonadherence to drug therapy in cSLE and other chronic rheumatic conditions, including forgetfulness, low socioeconomic status, family disruption, polypharmacy, and psychiatric comorbidities [ 37 , 177 , 178 ]. Poor compliance contributes to negatives outcomes and decreases the health-related quality of life [ 179 – 181 ].…”

Section: Drug Adherence For Adolescentsmentioning

confidence: 99%

“…Thus, it is recommended that medication adherence should be checked during the pediatric rheumatologist appointments, especially before any decisions around treatment modifications [ 2 , 96 ]. Understanding and responding to adolescent demands with a personalized treatment plan and multidisciplinary teams, including psychological/psychiatric support, health education strategies, and adherence interventions may help cSLE teens to increase compliance with treatment [ 37 , 174 , 176 , 181 , 182 ].…”

Section: Drug Adherence For Adolescentsmentioning

confidence: 99%

“…Most treatments in cSLE and adult-onset SLE are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series [ 1 , 2 , 13 , 18 , 19 ]. Racial/ethnic background, cost of medications, poor adherence, and specifically social determinants of health seem to impact lupus outcomes and treatment response [ 18 , 19 , 37 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

et al. 2021

Self Cite

View full text Add to dashboard Cite

Childhood-onset systemic lupus erythematosus (cSLE) is a prototype of a multisystemic, inflammatory, heterogeneous autoimmune condition. This disease is characterized by simultaneous or sequential organ and system involvement, with unpredictable flare and high levels of morbidity and mortality. Racial/ethnic background, socioeconomic status, cost of medications, difficulty accessing health care, and poor adherence seem to impact lupus outcomes and treatment response. In this article, the management of cSLE patients is updated. Regarding pathogenesis, a number of potential targets for drugs have been studied. However, most treatments in pediatric patients are off-label drugs with recommendations based on inadequately powered studies, therapeutic consensus guidelines, or case series. Management practices for cSLE patients include evaluations of disease activity and cumulative damage scores, routine non-live vaccinations, physical activity, and addressing mental health issues. Antimalarials and glucocorticoids are still the most common drugs used to treat cSLE, and hydroxychloroquine is recommended for nearly all cSLE patients. Disease-modifying antirheumatic drugs (DMARDs) should be standardized for each patient, based on disease flare and cSLE severity. Mycophenolate mofetil or intravenous cyclophosphamide is suggested as induction therapy for lupus nephritis classes III and IV. Calcineurin inhibitors (cyclosporine, tacrolimus, voclosporin) appear to be another good option for cSLE patients with lupus nephritis. Regarding B-cell-targeting biologic agents, rituximab may be used for refractory lupus nephritis patients in combination with another DMARD, and belimumab was recently approved by the US Food and Drug Administration for cSLE treatment in children aged > 5 years. New therapies targeting CD20, such as atacicept and telitacicept, seem to be promising drugs for SLE patients. Anti-interferon therapies (sifalimumab and anifrolumab) have shown beneficial results in phase II randomized control trials in adult SLE patients, as have some Janus kinase inhibitors, and these could be alternative treatments for pediatric patients with severe interferon-mediated inflammatory disease in the future. In addition, strict control of proteinuria and blood pressure is required in cSLE, especially with angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use.

show abstract

Section: Drug Adherence For Adolescentsmentioning

confidence: 99%

Section: Drug Adherence For Adolescentsmentioning

confidence: 99%

Section: Drug Adherence For Adolescentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The main goal of therapy in pediatric APS is the prevention of re-thrombosis, so treatment studies and recommendations are primarily focused on secondary thromboprophylaxis [1]. Given that most pediatric patients with APS are adolescents [12][13][14], management strategies should include other relevant aspects such as screening for additional prothrombotic risk factors, contraceptive strategies, lifestyle recommendations, treatment adherence, and mental health issues associated with this autoimmune thrombosis [9,[86][87][88].…”

Section: General Managementmentioning

confidence: 99%

Managing Antiphospholipid Syndrome in Children and Adolescents: Current and Future Prospects

et al. 2021

Self Cite

View full text Add to dashboard Cite

Pediatric antiphospholipid syndrome (APS) is a rare acquired multisystem autoimmune thromboinflammatory condition characterized by thrombotic and non-thrombotic clinical manifestations. APS in children and adolescents typically presents with large-vessel thrombosis, thrombotic microangiopathy, and, rarely, obstetric morbidity. Non-thrombotic clinical manifestations are frequently seen in pediatric APS and may be present even before the vascular thrombotic events occur. We review insights into the pathogenesis of APS and discuss potential targets for therapy. The identification of multiple immunologic abnormalities in patients with APS reveals molecular targets for current or future treatment. Management strategies, especially for APS in adolescents, require screening for additional prothrombotic risk factors and consideration of counseling regarding contraceptive strategies, lifestyle recommendations, treatment adherence, and mental health issues associated with this autoimmune thrombophilia. The main goal of therapy in pediatric APS is the prevention of thrombosis. The management of acute thrombosis events in children and adolescents is the same as for primary APS, which involves isolated occurrences, and secondary APS, which is seen in association with another autoimmune disease, e.g., systemic lupus erythematosus. A pediatric hematologist should be consulted so other differential thrombophilic conditions can be eliminated. Therapy includes unfractionated heparin or low-molecular-weight heparin followed by vitamin K antagonists. Treatment of catastrophic APS involves triple therapy (anticoagulation, intravenous corticosteroid pulse therapy, and plasma exchange) and may include intravenous immunoglobulin for children and adolescents with this condition. New drugs such as eculizumab and sirolimus seem to be promising drugs for APS.

show abstract

La consulta de enfermería para adolescentes: una parte importante de los cuidados prestados por los profesionales de enfermería en un estado brasileño

Robba

Costa

Monteiro

et al. 2022

Rev. Latino-Am. Enfermagem

View full text Add to dashboard Cite

Resumen Objetivo: el cuidado de los adolescentes con o sin enfermedad crónica debe ser completo, estandarizado y centrado en las demandas individuales y en el proceso de transición a la atención para adultos y la adherencia al tratamiento. Este estudio tuvo como objetivo caracterizar los cuidados prestados por el personal de enfermería del estado de São Paulo que trabaja con adolescentes. Método: se trata de un estudio transversal y descriptivo sobre los cuidados prestados a los adolescentes por el personal de enfermería de São Paulo, a partir de las respuestas a un cuestionario autoadministrado, disponible en la herramienta REDCap entre agosto de 2018 y octubre de 2019. Resultados: los participantes respondieron a 1.632 cuestionarios. Solo el 38% del personal de enfermería trabaja con adolescentes, el 11,2% de forma exclusiva. Los profesionales se dividieron según la duración media de la experiencia profesional en los grupos A y B (≤5 años y >5 años). La drogadicción (p=0,01) y el trabajo con un equipo multidisciplinar (p=0,04) fueron significativamente más reportados en el grupo B. El seguimiento rutinario (p=0,02) y las preguntas sobre violencia sexual o física (p=0,03) fueron significativamente más realizadas por los profesionales del grupo A. Conclusión: este estudio identificó la necesidad de un protocolo de atención que pueda ser replicado a gran escala y que incluya el tratamiento y las particularidades de los adolescentes para mejorar la adherencia y la transición a la atención de adultos.

show abstract

Poor Adherence to Drug Treatment in Children and Adolescents With Autoimmune Rheumatic Diseases

Cited by 6 publications

References 5 publications

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus

Managing Antiphospholipid Syndrome in Children and Adolescents: Current and Future Prospects

La consulta de enfermería para adolescentes: una parte importante de los cuidados prestados por los profesionales de enfermería en un estado brasileño

Contact Info

Product

Resources

About