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A Scoping Review of Medications Studied in Pediatric Polypharmacy Research

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Abstract

Purpose

The purpose of this study is to describe medications most commonly studied in pediatric polypharmacy research by pharmacologic classes and disease using a scoping review methodology.

Methods

A search of electronic databases was conducted in July 2019 that included Ovid Medline, PubMed, Elsevier Embase, and EBSCO CINAHL. Primary observational studies were selected if they evaluated polypharmacy as an aim, outcome, predictor, or covariate in children 0–21 years of age. Studies not differentiating between adults and children or those not written in English were excluded. Study characteristics, pharmacologic categories, medication classes, and medications were extracted from the included studies.

Results

The search identified 8790 titles and after de-duplicating and full-text screening, 414 studies were extracted for the primary data. Regarding global pharmacologic categories, central nervous system (CNS) agents were most studied (n = 185, 44.9%). The most reported pharmacologic category was the anticonvulsants (n = 250, 60.4%), with valproic acid (n = 129), carbamazepine (n = 123), phenobarbital (n = 87), and phenytoin (n = 83) being the medications most commonly studied. In studies that reported medication classes (n = 105), serotonin reuptake inhibitors (n = 32, 30.5%), CNS stimulants (n = 30, 28.6%), and mood stabilizers (n = 27, 25.7%) were the most studied medication classes.

Conclusion

While characterizing the literature on pediatric polypharmacy in terms of the types of medication studied, we further identified substantive gaps within this literature outside of epilepsy and psychiatric disorders. Medications frequently identified in use of polypharmacy for treatment of epilepsy and psychiatric disorders reveal opportunities for enhanced medication management in pediatric patients.

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Acknowledgements

We thank our expert stakeholders whose contribution at different stages of the project improved our research protocol, data quality, interpretation, and reporting: Dr. Joseph Calabrese, Dr. Faye Gary, Dr. Cynthia Fontanella, and Dr. Mai Pham. Thank you to Ms. Jennifer Staley, Dr. Sharon Meropol, Dr. Shari Bolen, and Dr. Almut Winterstein for their integral part in developing our methodology. We are also grateful to Ms. Courtney Baker and Ms. Rujia Liu, who conducted a great amount of study screening, data extraction, data cleaning, quality checks, processing, and analysis. Finally, we show appreciation to Ms. Tenerica Madison for her help in the development of our charts.

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Authors and Affiliations

  1. College of Pharmacy, University of Louisiana at Monroe, Monroe, LA, USA

    Alexis E. Horace

  2. School of Pharmacy, University of Washington, Seattle, WA, USA

    Negar Golchin

  3. Epilepsy Center/Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Elia M. Pestana Knight

  4. Center for Health Care Research and Policy, MetroHealth, Cleveland, OH, USA

    Neal V. Dawson

  5. Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA

    Neal V. Dawson

  6. Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA

    Xuan Ma, Hannah K. Johnson & Paul M. Bakaki

  7. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    James A. Feinstein

  8. Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA

    Lawrence Kleinman

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  1. Alexis E. Horace
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Correspondence to Alexis E. Horace.

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Conflict of interest

The authors, Alexis E. Horace, Negar Golchin, Elia M. Pestana Knight, Neal V. Dawson, Xuan Ma, James A. Feinstein, Hannah K. Johnson, Lawrence Kleinman, and Paul M. Bakaki, certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Funding

National Center for Advancing Translational Sciences (Clinical and Translational Science Collaborative of Cleveland): KL2TR002547; Eunice Kennedy Shriver National Institute for Child Health and Human Development: K23 HD091295.

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Horace, A.E., Golchin, N., Knight, E.M.P. et al. A Scoping Review of Medications Studied in Pediatric Polypharmacy Research. Pediatr Drugs 22, 85–94 (2020). https://doi.org/10.1007/s40272-019-00372-4

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