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. 2024 Sep 4;33(173):240011.
doi: 10.1183/16000617.0011-2024. Print 2024 Jul.

Adherence-enhancing interventions for pharmacological and oxygen therapy in patients with COPD: a systematic review and component network meta-analyses

Omar Ammous  1 , Regina Kampo  2 , Maximilian Wollsching-Strobel  3   4 , Maximilian Zimmermann  3   4 , Stefan Andreas  5 , Tim Friede  2 , Doreen Kroppen  3   4 , Sarah Stanzel  3   4 , Susanna Salem  2 , Wolfram Windisch  3   4 , Tim Mathes  2
Affiliations

Adherence-enhancing interventions for pharmacological and oxygen therapy in patients with COPD: a systematic review and component network meta-analyses

Omar Ammous et al. Eur Respir Rev. .

Abstract

Introduction: Adherence to COPD management strategies is complex, and it is unclear which intervention may enhance it.

Objectives: We aim to evaluate the effectiveness of adherence-enhancing interventions, alone or compared to interventions, for patients with COPD.

Methods: This review comprises a component network meta-analysis with a structured narrative synthesis. We searched MEDLINE, Embase, CENTRAL, CINAHL and trial registries on 9 September 2023. We included controlled studies that explored adherence in patients with COPD. Two review authors independently performed the study selection, data extraction and the risk of bias assessment. We involved patients with COPD in developing this systematic review through focus group interviews and displayed the findings in pre-designed logic models.

Results: We included 33 studies with 5775 participants. We included 13 studies in the component network meta-analysis that explored adherence. It was mainly assessed through questionnaires. As a continuous outcome, there was a tendency mainly for education (standardised mean difference 1.26, 95% CI 1.13-1.38, very low certainty of evidence) and motivation (mean difference 1.85, 95% CI 1.19-2.50, very low certainty of evidence) to improve adherence. As a dichotomous outcome (e.g. adherent/non-adherent), we found a possible benefit with education (odds ratio 4.77, 95% CI 2.25-10.14, low certainty of evidence) but not with the other components. We included six studies that reported quality of life in the component network meta-analysis. Again, we found a benefit of education (mean difference -9.70, 95% CI -10.82- -8.57, low certainty of evidence) but not with the other components.

Conclusions: Education may improve adherence and quality of life in COPD patients. Patient focus group interviews indicated that interventions that strengthen patients' self-efficacy and help them to achieve individual goals are the most helpful.

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Conflict of interest statement

Conflict of interest: S. Andreas reports grants from Boehringer, and personal fees from Boehringer, AZ, GSK, Chiesi, Novartis and Menerini, outside the submitted work. T. Friede reports personal fees for statistical consultancies, including data monitoring committees, from Actimed, Aslan, Bayer, Biosense Webster, BMS, CSL Behring, Enanta, Fresenius Kabi, Galapagos, IQVIA, Immunic, Janssen, Kyowa Kirin, LivaNova, Minoryx, Norvartis, PPD, Recardio, Relaxera, Roche, Servier, Viatris, VICO Therapeutics and Vifor, all outside the submitted work. The other authors declare no competing interests.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow diagram.
FIGURE 2
FIGURE 2
Star-shaped component network meta-analysis for adherence (continuous).
FIGURE 3
FIGURE 3
Star-shaped component network meta-analysis for adherence (dichotomous).
FIGURE 4
FIGURE 4
Star-shaped component network meta-analysis for health-related quality of life (as assessed by the St George's Respiratory Questionnaire).
FIGURE 5
FIGURE 5
System-based logic model supplemented by the patient concept on the topic of therapy adherence. Red text represents areas of patient focus; purple text represents patient suggestions. QoL: quality of life.
FIGURE 6
FIGURE 6
Process-oriented logic model supplemented by the patient concept on the topic of therapy adherence. Green squares represent areas of patient focus; purple text represents patient suggestions. QoL: quality of life.
See this image and copyright information in PMC

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