药物对吸入治疗的坚持和COPD恶化的风险:通过元分析进行系统审查
Delphine Vauterin1, Frauke Van Vaerenbergh1, Maxim Grymonprez1
1Faculty of Pharmaceutical Sciences, Department of Bioanalysis, Ghent University, Ghent, Belgium.
BMJ open respiratory research
|September 20, 2024
概括
缺乏对COPD药物治疗的坚持将使COPD恶化的风险增加40%. 这项研究分析了药物持有率和覆盖日数的比例,无论评估方法如何,发现风险总是更高.
科学领域:
- 肺部医学 肺部医学
- 药物经济学 药物经济学
- 现实世界的证据 现实世界的证据
背景情况:
- 药物坚持对于管理慢性阻塞性肺病 (COPD) 和预防恶化至关重要.
- 评估方法和值对COPD的坚持-恶化联系的影响仍然不清楚.
- 电子医疗数据库为COPD恶化和药物坚持提供了有价值的现实洞察力.
研究的目的:
- 系统地审查COPD恶化的医疗保健数据库中使用的依从性评估方法和值.
- 对药物坚持和COPD恶化之间的关联效果大小进行元分析.
主要方法:
- 在MEDLINE,Web of Science和Embase的系统文献搜索到2022年10月.
- 坚持性评估方法和值的定性描述;效果大小的定量元分析 (随机效应模型).
- 包括八项研究进行审查,五项进行元分析,使用药物占有率 (MPR) 和覆盖日数比例 (PDC) 以0.80的门.
主要成果:
- 较差的坚持 (MPR或PDC<0.80) 与40%增加的COPD恶化风险 (OR1.40,95% CI 1.21至1.62) 显著相关.
- 这种关联无论依从性评估方法 (MPR或PDC) 或恶化的严重程度如何,都保持一致.
- 一个依赖时间的分析也显示了不良坚持和COPD恶化之间存在显著的关联 (IRR1.31,95%CI1.17至1.46).
结论:
- 对吸入器药物的不良坚持显著增加了COPD恶化的风险约40%.
- 标准化依从性评估方法 (MPR,PDC) 和0.80的值通常用于现实世界COPD研究.
- 调查结果强调了在COPD管理中监测和改善药物服药的重要性.
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