J Am Pharm Assoc (2003). 2020 Sep-Oct;60(5):669-685.e2. doi: 10.1016/j.japh.2020.02.010. Epub 2020 Mar 17.
To assess the association between adherence levels and severe asthma exacerbation.
A systematic search was performed from inception to November 2018 on the following databases: PubMed, CENTRAL, EMBASE, and ClinicalTrials.gov.
Randomized-controlled trials (RCTs) and cohort and case-control studies that investigated the impact of adherence to controller medications on severe asthma exacerbation were included in the analysis. Data extraction was undertaken by 2 reviewers, and all studies were assessed for their qualities using the Cochrane risk of bias tool for RCT and the Newcastle-Ottawa scale for cohort and case-control studies. Random-effects model meta-analyses were performed.
Severe asthma exacerbation.
From 8061 articles, 8 studies were included in quantitative synthesis. The meta-analyses revealed that the odds of exacerbation among the patients with 80% or more adherence were lowered by 47% (odds ratio 0.53 [95% CI 0.42-0.66], P < 0.001) compared with less than 80%. When compared with less than 20% adherence, a 33% reduction in the odds (0.67 [0.53-0.86], P = 0.001) was associated with the patients achieving 50% or more, whereas a decrease in exacerbation was not associated with 20% to 49% adherence (0.94 [0.85-1.04], P = 0.22). In addition, a 2.4-fold increase in the odds (2.4 [2.1-2.7], P < 0.001) was associated with discontinuation of therapy.
The highest reduction in the odds of exacerbation was associated with patients achieving 80% or more adherence, and the odds also reduced among those with 50% or more adherence, whereas a substantial increase in exacerbation was associated with discontinuation of therapy.
评估依从水平与重度哮喘恶化之间的关联。
从创建到 2018 年 11 月，在以下数据库中进行了系统搜索：PubMed、CENTRAL、EMBASE 和 ClinicalTrials.gov。
纳入的分析包括调查依从性对控制器药物治疗重度哮喘恶化影响的随机对照试验（RCT）和队列研究以及病例对照研究。由 2 名评审员进行数据提取，使用 Cochrane RCT 偏倚风险工具和纽卡斯尔-渥太华量表对所有研究进行质量评估。进行了随机效应模型荟萃分析。
重度哮喘恶化。
从 8061 篇文章中，有 8 项研究纳入定量综合分析。荟萃分析显示，在 80%或更高依从性的患者中，恶化的几率降低了 47%（比值比 0.53 [95%CI 0.42-0.66]，P < 0.001），而依从性低于 80%。与依从性低于 20%相比，50%或更高的依从性可使几率降低 33%（0.67 [0.53-0.86]，P = 0.001），而与 20%至 49%的依从性相关的恶化则无降低（0.94 [0.85-1.04]，P = 0.22）。此外，与继续治疗相比，停药与几率增加 2.4 倍（2.4 [2.1-2.7]，P < 0.001）相关。
与依从性达到 80%或更高的患者相比，几率降低幅度最大，而与依从性达到 50%或更高的患者相比，几率也降低，而停药则与恶化几率显著增加相关。
