吸入疗法药物依从性与 COPD 加重风险：系统评价与荟萃分析。
Medication adherence to inhalation therapy and the risk of COPD exacerbations: a systematic review with meta-analysis.
机构信息
Faculty of Pharmaceutical Sciences, Department of Bioanalysis, Ghent University, Ghent, Belgium.
Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
出版信息
BMJ Open Respir Res. 2024 Sep 19;11(1):e001964. doi: 10.1136/bmjresp-2023-001964.
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, I=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.
PROSPERO REGISTRATION NUMBER
CRD42022363449.
背景
评估药物依从性对于慢性阻塞性肺疾病（COPD）管理至关重要，可预防病情加重。然而，药物依从性与加重事件之间的关联是否受到所使用的依从性评估方法或阈值的影响尚不清楚。电子医疗保健数据库对于在真实生活中研究加重事件和依从性非常有价值。我们旨在系统地回顾文献，以确定在调查药物依从性与 COPD 加重之间的关联时，医疗保健数据库中使用的依从性评估方法和阈值，并对相关效应大小进行荟萃分析。
方法
检索了 MEDLINE、Web of Science 和 Embase 中截至 2022 年 10 月 10 日发表的同行评议英文文章（PROSPERO：CRD42022363449）。两名审查员独立进行了纳入筛选和数据提取。采用定性方法描述了所使用的依从性评估方法和阈值。采用定量方法（使用随机效应模型的荟萃分析）估计了依从性与 COPD 加重风险之间的关联。
结果
系统综述共纳入 8 项研究，其中 5 项研究纳入荟萃分析。药物暴露率（MPR）和覆盖天数比例（PDC）是常用的依从性评估方法，0.80 始终用于区分良好依从性和不良依从性。依从性和加重通常在同一时间段内进行测量。不良依从性（MPR 或 PDC<0.80）与 COPD 加重风险显著增加相关（OR 1.40，95%CI 1.21 至 1.62，I=85%），而与所使用的依从性评估方法无关。按加重严重程度分层时，结果一致。不良依从性也与 COPD 加重的时间依赖性风险相关（发病率比 1.31，95%CI 1.17 至 1.46）。
结论
我们的系统综述和荟萃分析表明，吸入药物依从性差会使 COPD 加重的风险增加 40%。
PROSPERO 注册号：CRD42022363449。
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