Effects of timing and scheduling in levothyroxine adherence to hypothyroidism control: Meta-analysis with trial sequential analysis of Randomized Clinical Trials.

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2025-04-12 DOI:10.1007/s12020-025-04229-4

Bruno Simas da Rocha, Vitor Bock Silveira, Dimitris Varvaki Rados, André Borsato Zanella, Rafael Selbach Scheffel, Ana Luiza Maia, Jose Miguel Dora

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引用次数: 0

Abstract

Purpose: Treatment adherence for chronic conditions is a common clinical challenge. This systematic review aimed to assess the impact of scheduling and timing on levothyroxine adherence in patients with hypothyroidism.

Methods: We searched multiple databases (PubMed, EMBASE, SCOPUS, Web Of Science, and CINAHL) using relevant terms related to hypothyroidism and medication adherence. Two independent reviewers conducted study selection, evaluation, and data extraction. The primary outcome was thyrotropin (TSH) levels, analyzed using inverse-variance meta-analysis. Trial sequential analysis (TSA) was conducted to assess the statistical reliability of the meta-analyses results.

Results: Of the 706 articles initially found, 11 met the inclusion criteria: eight assessed evening administration and three evaluated weekly administration of levothyroxine. Comparison between evening and morning administration showed no significant difference in changes of TSH levels (dTSH 0.18; 95% confidence interval [95%CI] -0.29-0.65, P = 0.46). However, considering weekly administration of levothyroxine, TSH levels were higher in the experimental group (dTSH 1.14; 95%CI 0.80-1.14, P < 0.01), although the mean final TSH remained within the reference range in both groups. TSA indicated that the required information size was achieved for scheduling interventions.

Conclusion: Both daily timing and weekly administration of levothyroxine were effective in maintaining TSH levels within reference values. Individualized dosing regimens may be considered based on patient convenience and preference.

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时间和计划对左旋甲状腺素依从性控制甲状腺功能减退的影响：随机临床试验的荟萃分析。

目的：慢性疾病的治疗依从性是一个常见的临床挑战。本系统综述旨在评估计划和时间对甲状腺功能减退患者左旋甲状腺素依从性的影响。方法：我们检索了多个数据库（PubMed， EMBASE， SCOPUS， Web Of Science和CINAHL），使用与甲状腺功能减退和药物依从性相关的相关术语。两名独立审稿人进行了研究选择、评估和数据提取。主要终点是促甲状腺激素（TSH）水平，使用反方差荟萃分析进行分析。采用试验序贯分析（TSA）评估meta分析结果的统计可靠性。结果：在最初发现的706篇文章中，11篇符合纳入标准：8篇评估晚间给药，3篇评估每周给药左甲状腺素。早晚给药比较，TSH水平变化无显著性差异(dTSH 0.18；95%置信区间[95% ci] -0.29-0.65, P = 0.46)。然而，考虑到每周给药左甲状腺素，实验组的TSH水平更高(dTSH 1.14；结论：每日定时和每周给药左甲状腺素均可有效维持TSH水平在参考值范围内。可根据患者的方便和偏好考虑个体化给药方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.