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Adherence Enhancing Interventions for Pharmacological and Oxygen Therapy in Patients with COPD: A Systematic Review and Component Network Meta-Analyses

31 Pages Posted: 11 Dec 2023

See all articles by Omar Ammous

Omar Ammous

University of Goettingen (Göttingen) - University Medical Centre

Stefan Andreas

University of Goettingen (Göttingen) - University Medical Centre

T. Friede

University of Goettingen (Göttingen) - University Medical Centre

Regina Kampo

University of Goettingen (Göttingen) - University Medical Centre

Doreen Kroppen

University of Witten/Herdecke

Sarah Schwarz

University of Witten/Herdecke

Maximilian Wollsching-Strobel

University of Witten/Herdecke

Susanna Salem

University of Goettingen (Göttingen) - University Medical Centre

Wolfram Windisch

University of Witten/Herdecke

Maximilian Zimmermann

University of Witten/Herdecke

Tim Mathes

University of Goettingen (Göttingen) - University Medical Centre

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Abstract

Background: Adherence to COPD management strategies is challenging. We aim to evaluate the effectiveness of adherence-enhancing interventions, alone or compared to other adherence-enhancing interventions, for patients with COPD.

Methods: This review comprises a component network meta-analysis (CNMA) with a structured narrative synthesis. We searched MEDLINE, EMBASE, CENTRAL, CINHAL and trial registries on 09/2023. 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 displayed the findings in pre-designed logic models.

Main results: We included 33 studies with 5775 participants. We included 13 studies in the CNMA that explored adherence. It was mainly assessed through questionnaires. As a continuous outcome, there was a tendency mainly for education (MD 1.6; 95% CI 1.13 to 1.38, very low certainty of evidence) and motivation (MD 1.85; 95 % CI 1.19 to 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 (OR 4.77; 95% CI 2.25 to 10.14, low certainty of evidence) but not with the other components. We included six studies that reported quality of life in the CNMA. Again, we found a benefit of education (MD -9.70; 95 % CI -10.82 to -8.57, low certainty of evidence) but not for the other components.

Interpretation: Education may improve adherence and quality of life in COPD patients. Focus-group interviews emphasised face-to-face interventions, quality of life as an essential outcome, and self-efficacy as key to promoting adherence.Future research should directly compare different intervention components, single vs. multiple-component interventions, and standardise outcome measurements.

Funding: German Federal Ministry of Education and Research (BMBF).Grant number 01KG2205.

Declaration of Interest: Stefan Andreas reports grants from Boehringer, and personal fees from Boehringer, AZ, GSK, Chiesi, GSK, Novartis, and Menerini outside the submitted work. Tim Friede reports personal fees for statistical consultancies including data monitoring committees from Actimed, Aslan, Bayer, BiosenseWebster, BMS, CSLBehring, Enanta, Fresenius Kabi, Galapagos, IQVIA, Immunic, Janssen, KyowaKirin, LivaNova, Minoryx, Norvartis, PPD, Recardio, Relaxera, Roche, Servier, Viatris, VICO Therapeutics, Vifor; all outside the submitted work. The other authors declare no competing interests.

Keywords: COPD, Systematic Review, Component network Meta-analysis, Focus Group Interview, Intervention Complexity, Risk of Bias, Certainty of Evidence

Suggested Citation

Ammous, Omar and Andreas, Stefan and Friede, T. and Kampo, Regina and Kroppen, Doreen and Schwarz, Sarah and Wollsching-Strobel, Maximilian and Salem, Susanna and Windisch, Wolfram and Zimmermann, Maximilian and Mathes, Tim, Adherence Enhancing Interventions for Pharmacological and Oxygen Therapy in Patients with COPD: A Systematic Review and Component Network Meta-Analyses. Available at SSRN: https://ssrn.com/abstract=4657431 or http://dx.doi.org/10.2139/ssrn.4657431

Omar Ammous (Contact Author)

University of Goettingen (Göttingen) - University Medical Centre ( email )

Stefan Andreas

University of Goettingen (Göttingen) - University Medical Centre ( email )

T. Friede

University of Goettingen (Göttingen) - University Medical Centre ( email )

Goettingen
Germany

Regina Kampo

University of Goettingen (Göttingen) - University Medical Centre ( email )

Doreen Kroppen

University of Witten/Herdecke ( email )

Sarah Schwarz

University of Witten/Herdecke ( email )

Maximilian Wollsching-Strobel

University of Witten/Herdecke ( email )

Susanna Salem

University of Goettingen (Göttingen) - University Medical Centre ( email )

Wolfram Windisch

University of Witten/Herdecke ( email )

Maximilian Zimmermann

University of Witten/Herdecke ( email )

Tim Mathes

University of Goettingen (Göttingen) - University Medical Centre ( email )