Delphine Vauterin, Frauke Van Vaerenbergh, Maxim Grymonprez, Anna Vanoverschelde, Lies Lahousse
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We aimed to systematically review the literature to identify adherence assessment methods and thresholds used in healthcare databases when investigating the association between medication adherence and COPD exacerbations and to meta-analyse the associated effect sizes.</p><p><strong>Method: </strong>MEDLINE, Web of Science and Embase were searched for peer-reviewed articles, written in English, published up to 10 October 2022 (PROSPERO: CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. A qualitative approach described the adherence assessment methods and thresholds used. A quantitative approach (meta-analysis using random effects model) estimated the association between adherence and the risk of COPD exacerbations.</p><p><strong>Results: </strong>Eight studies were included in the systematic review of which five studies were included in the meta-analysis. 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引用次数: 0
摘要
背景：在慢性阻塞性肺病（COPD）的治疗过程中，评估用药依从性对预防病情恶化至关重要。然而，依从性与病情加重之间的关系是否受依从性评估方法或所用阈值的影响尚不清楚。电子医疗数据库对于研究现实生活中的病情加重和依从性非常有价值。我们的目的是系统性地回顾文献，以确定医疗数据库在研究用药依从性与慢性阻塞性肺病加重之间的关系时所使用的依从性评估方法和阈值，并对相关效应大小进行元分析：检索了MEDLINE、Web of Science和Embase上截至2022年10月10日发表的同行评议文章（PROSPERO：CRD42022363449）。两名审稿人分别独立进行了纳入筛选和数据提取。定性方法描述了所使用的依从性评估方法和阈值。定量方法（使用随机效应模型进行荟萃分析）估算了依从性与慢性阻塞性肺疾病恶化风险之间的关系：系统综述共纳入了八项研究，其中五项纳入了荟萃分析。所采用的依从性评估方法是药物持有率（MPR）和覆盖天数比例（PDC），并始终以 0.80 作为区分依从性好坏的阈值。对依从性和病情恶化的测量大多在同一时期进行。无论采用哪种依从性评估方法，依从性差（MPR 或 PDC2=85%）。按病情加重严重程度分层后，结果一致。依从性差还与慢性阻塞性肺疾病加重的时间依赖性风险有关（发病率比为 1.31，95% CI 为 1.17 至 1.46）：我们的系统综述和荟萃分析表明，如果吸入器用药依从性差，慢性阻塞性肺病恶化的风险会增加 40%：CRD42022363449。
Medication adherence to inhalation therapy and the risk of COPD exacerbations: a systematic review with meta-analysis.
Background: Assessing medication adherence is crucial in chronic obstructive pulmonary disease (COPD) management to prevent exacerbations. However, it is unclear whether this association between adherence and exacerbations is influenced by the adherence assessment methods or thresholds used. Electronic healthcare databases are valuable to study exacerbations and adherence in real life. We aimed to systematically review the literature to identify adherence assessment methods and thresholds used in healthcare databases when investigating the association between medication adherence and COPD exacerbations and to meta-analyse the associated effect sizes.
Method: MEDLINE, Web of Science and Embase were searched for peer-reviewed articles, written in English, published up to 10 October 2022 (PROSPERO: CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. A qualitative approach described the adherence assessment methods and thresholds used. A quantitative approach (meta-analysis using random effects model) estimated the association between adherence and the risk of COPD exacerbations.
Results: Eight studies were included in the systematic review of which five studies were included in the meta-analysis. The medication possession ratio (MPR) and the proportion of days covered (PDC) were the adherence assessment methods used and 0.80 was always used as threshold to differentiate good from poor adherence. Adherence and exacerbations were mostly measured over the same time period. Poor adherence (MPR or PDC<0.80) was significantly associated with a higher COPD exacerbation risk (OR 1.40, 95% CI 1.21 to 1.62, I2=85%), regardless of the adherence assessment method used. Results were consistent when stratified by exacerbation severity. Poor adherence was also associated with a time-dependent risk of COPD exacerbations (incidence rate ratio 1.31, 95% CI 1.17 to 1.46).
Conclusion: Our systematic review with meta-analysis demonstrated a 40% increased risk of COPD exacerbations in case of poor adherence to inhaler medication.
期刊介绍：
BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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