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Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis
Objective: We conducted a large-scale meta-analysis and subgroup analysis to compare the effect of fixed-dose combination (FDC) therapy with that of free-equivalent combination (FEC) therapy on medication adherence. Methods: Studies published in Web of Science, PubMed, Cochrane Library, ScienceDirec...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074603/ https://www.ncbi.nlm.nih.gov/pubmed/37033611 http://dx.doi.org/10.3389/fphar.2023.1156081 |
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author | Wei, Qiran Zhou, Jiting Li, Hongchao Wang, Luying Wu, Yao Ma, Aixia Guan, Xin |
author_facet | Wei, Qiran Zhou, Jiting Li, Hongchao Wang, Luying Wu, Yao Ma, Aixia Guan, Xin |
author_sort | Wei, Qiran |
collection | PubMed |
description | Objective: We conducted a large-scale meta-analysis and subgroup analysis to compare the effect of fixed-dose combination (FDC) therapy with that of free-equivalent combination (FEC) therapy on medication adherence. Methods: Studies published in Web of Science, PubMed, Cochrane Library, ScienceDirect, and Embase up to May 2022 were identified according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary assessed outcomes were the medication possession ratio (MPR) and proportion of days covered (PDC). We investigated the probability of being adherent to the prescribed treatment (MPR or PDC ≥80%) or the average estimate of these two parameters. Studies reporting such results were included in this meta-analysis. The summary measures were reported as the risk ratio (RR) and the weighted mean difference (MD) with 95% of confidence interval (CI) using the random-effects model of DerSimonian and Laird. The quality of the cohort studies was assessed using the Newcastle-Ottawa scale. Results: Of the 1,814 screened studies, 61 met the predefined inclusion criteria. The meta-analysis of the results showed that compared to FEC, FDC significantly improved the medication compliance of patients by 1.29 times (95% CI:1.23–1.35, p < 0.00001). I(2) of 99% represent high heterogeneity across studies. The mean difference in medication adherence between FDC and FEC was 0.10 (95% CI: 0.06–0.14, p < 0.00001) with an I(2) estimate of 100%. Subgroup analyses were performed for studies that reported adherence outcomes according to disease type, period of evaluation and compliance indicators. A sensitivity analysis was conducted to exclude the results of low-quality studies, as well as studies in which there was ambiguity in the method of calculating the estimator. Conclusion: Analysis of the assessed parameters for the intention-to-treat and subgroup populations suggests that FDC can improve adherence to treatment and its advantages over FEC may increase over time. Further research is needed to better understand how medical conditions affect the impact of reduced pill burden on adherence, particularly in diseases other than cardiovascular disease and type 2 diabetes mellitus. |
format | Online Article Text |
id | pubmed-10074603 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100746032023-04-06 Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis Wei, Qiran Zhou, Jiting Li, Hongchao Wang, Luying Wu, Yao Ma, Aixia Guan, Xin Front Pharmacol Pharmacology Objective: We conducted a large-scale meta-analysis and subgroup analysis to compare the effect of fixed-dose combination (FDC) therapy with that of free-equivalent combination (FEC) therapy on medication adherence. Methods: Studies published in Web of Science, PubMed, Cochrane Library, ScienceDirect, and Embase up to May 2022 were identified according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary assessed outcomes were the medication possession ratio (MPR) and proportion of days covered (PDC). We investigated the probability of being adherent to the prescribed treatment (MPR or PDC ≥80%) or the average estimate of these two parameters. Studies reporting such results were included in this meta-analysis. The summary measures were reported as the risk ratio (RR) and the weighted mean difference (MD) with 95% of confidence interval (CI) using the random-effects model of DerSimonian and Laird. The quality of the cohort studies was assessed using the Newcastle-Ottawa scale. Results: Of the 1,814 screened studies, 61 met the predefined inclusion criteria. The meta-analysis of the results showed that compared to FEC, FDC significantly improved the medication compliance of patients by 1.29 times (95% CI:1.23–1.35, p < 0.00001). I(2) of 99% represent high heterogeneity across studies. The mean difference in medication adherence between FDC and FEC was 0.10 (95% CI: 0.06–0.14, p < 0.00001) with an I(2) estimate of 100%. Subgroup analyses were performed for studies that reported adherence outcomes according to disease type, period of evaluation and compliance indicators. A sensitivity analysis was conducted to exclude the results of low-quality studies, as well as studies in which there was ambiguity in the method of calculating the estimator. Conclusion: Analysis of the assessed parameters for the intention-to-treat and subgroup populations suggests that FDC can improve adherence to treatment and its advantages over FEC may increase over time. Further research is needed to better understand how medical conditions affect the impact of reduced pill burden on adherence, particularly in diseases other than cardiovascular disease and type 2 diabetes mellitus. Frontiers Media S.A. 2023-03-22 /pmc/articles/PMC10074603/ /pubmed/37033611 http://dx.doi.org/10.3389/fphar.2023.1156081 Text en Copyright © 2023 Wei, Zhou, Li, Wang, Wu, Ma and Guan. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pharmacology Wei, Qiran Zhou, Jiting Li, Hongchao Wang, Luying Wu, Yao Ma, Aixia Guan, Xin Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis |
title | Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis |
title_full | Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis |
title_fullStr | Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis |
title_full_unstemmed | Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis |
title_short | Medication adherence with fixed-dose versus free-equivalent combination therapies: Systematic review and meta-analysis |
title_sort | medication adherence with fixed-dose versus free-equivalent combination therapies: systematic review and meta-analysis |
topic | Pharmacology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10074603/ https://www.ncbi.nlm.nih.gov/pubmed/37033611 http://dx.doi.org/10.3389/fphar.2023.1156081 |
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