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Medical Adherence to Acne Therapy: A Systematic Review

  • Systematic Review
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American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background

Poor adherence of acne patients to treatment may equate to poor clinical efficacy, increased healthcare costs, and unnecessary treatments. Authors have investigated risk factors for poor medical adherence and how to improve this difficult problem in the context of acne.

Objective

This systematic review aims to describe what methods have been used to measure adherence, what is known about acne patients’ adherence to treatment, and the factors affecting adherence.

Methods

A MEDLINE search was performed for randomized controlled trials published between 1978 and June 2013, focusing on patient adherence to prescribed acne medications. A test for equality of proportions was performed on studies of similar design to collectively analyze adherence to oral versus topical medication. The self-reported adherence data collected from these clinical trials were then compared with adherence data from a pharmacy database study.

Results

Studies varied in modalities of data collection, but the majority utilized subjective methods. Topical therapies were more often studied than oral. The overall oral adherence rate, as calculated by a test of equality of proportions, was 76.3 %, while the overall topical adherence rate was 75.8 % (p = 0.927). The occurrence of side effects and young age were cited as the top reasons for poor adherence, followed by forgetfulness.

Limitations

The MEDLINE search resulted in a limited sample of adherence studies. In addition, there is currently no standardized or fully validated method of measurement, allowing for variability in what was considered ‘adherent’. Lastly, data collected via subjective methods cannot guarantee reliable results.

Conclusions

Overall, the values reflected a population adherent to both topical and oral medications, with no significant difference in adherence between the two. However, the methodologies used by many of the studies were weak, and the findings are not consistent with results of more objective measures of adherence. The leading factors that contribute to poor adherence may be reduced with enhanced patient consultation, reminder systems, and education.

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Funding

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has received stock options from Photomedex. He is owner of www.DrScore.com and a founder of Causa Research. The other authors have no conflicts to disclose.

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Authors and Affiliations

  1. Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA

    Stephanie Snyder, Ian Crandell, Scott A. Davis & Steven R. Feldman

  2. Department of Pathology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

  3. Department of Public Health Sciences, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

Authors
  1. Stephanie Snyder
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  2. Ian Crandell
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  3. Scott A. Davis
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  4. Steven R. Feldman
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Corresponding author

Correspondence to Scott A. Davis.

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Snyder, S., Crandell, I., Davis, S.A. et al. Medical Adherence to Acne Therapy: A Systematic Review. Am J Clin Dermatol 15, 87–94 (2014). https://doi.org/10.1007/s40257-014-0063-y

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  • DOI: https://doi.org/10.1007/s40257-014-0063-y

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