Effectiveness and safety of apixaban versus rivaroxaban for prevention of recurrent venous thromboembolism and adverse bleeding events in patients with venous thromboembolism: a retrospective population-based cohort analysis

Dawwas, Ghadeer K.; Brown, Joshua D.; Dietrich, Eric; Park, Haesuk

doi:10.1016/s2352-3026(18)30191-1

Cited by 66 publications

(44 citation statements)

References 23 publications

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“…Both have a similar mechanism of action (factor Xa inhibitors), but rivaroxaban is a once‐daily regimen, whereas apixaban is twice daily. In comparative effectiveness studies, we and others have recently shown that risk of major bleeding is lower among users of apixaban than users of rivaroxaban. The extremely low use of dabigatran and edoxaban may be explained, at least partially, by their need for initial parenteral anticoagulation or differences in reimbursement relative to other OAC options.…”

Section: Resultsmentioning

confidence: 91%

Direct oral anticoagulants and warfarin for venous thromboembolism treatment: Trends from 2012 to 2017

Lutsey

Walker

MacLehose

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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BackgroundDirect oral anticoagulants (DOACs), namely rivaroxaban, apixaban, dabigatran, and edoxaban, are now included together with warfarin as standards of care for the primary treatment of venous thromboembolism (VTE). The extent to which the DOACs have been adopted since receiving US Food and Drug Administration (FDA) approval is unknown.ObjectiveTo document temporal trends in oral anticoagulant (OAC) prescriptions among anticoagulant‐naïve patients initiating OACs for VTE primary treatment in the United States and to report participant characteristics by OAC prescribed for the year 2017.MethodsMarketScan databases for years 2012 through 2017 were used to identify VTE cases and comorbidities using International Classification of Diseases codes and prescriptions for OACs via outpatient pharmaceutical claims data.ResultsThe 137 203 VTE cases were on average (± standard deviation) 56.7 ± 16.0 years old and 49.9% female. Warfarin was prescribed to 98.7% of VTE patients receiving an OAC in quarter 1 (January through March) of 2012. By quarter 4 (October through December) of 2017, warfarin was prescribed to 17.5%, while rivaroxaban was prescribed to 42.7%, apixaban to 38.6%, dabigatran to 1.3%, and edoxaban to <0.1%. In 2017, the comorbidity burden was highest among patients prescribed warfarin, intermediate among patients prescribed apixaban, and lowest among patients prescribed rivaroxaban.ConclusionsRivaroxaban and apixaban use to treat VTE has increased dramatically since receiving FDA approval, whereas warfarin use has plummeted. Dabigatran and edoxaban are infrequently prescribed. Given widespread usage of rivaroxaban and apixaban, there is a need for continued monitoring of the comparative effectiveness of these OAC therapies in real‐world settings.

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Section: Resultsmentioning

confidence: 91%

Direct oral anticoagulants and warfarin for venous thromboembolism treatment: Trends from 2012 to 2017

Lutsey

Walker

MacLehose

et al. 2019

Research and Practice in Thrombosis and Haemostasis

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“…Payments and charges including amounts paid by the health plan and the amount of patient responsibility are also captured. IBM MarketScan databases have been widely used for conducting retrospective observational studies of health outcomes in the US, such as this one, with more than 1,000 overall publications in peer‐reviewed journals …”

Section: Methodsmentioning

confidence: 99%

“…IBM MarketScan databases have been widely used for conducting retrospective observational studies of health outcomes in the US, such as this one, with more than 1,000 overall publications in peer-reviewed journals. [14][15][16][17][18] This database does not represent individuals who are enrolled only in a public health insurance program (eg, Medicare, Medicaid) with no supplemental private insurance or those who are unemployed and/or uninsured. Also, there are no restrictions based on age or economic status; however, because the database captures information on individuals employed with private insurance (or Medicare with a supplemental insurance), the population tends to be economically superior to those not represented in the data.…”

Section: Design and Data Sourcementioning

confidence: 99%

Treatment patterns, adverse events, and economic burden in a privately insured population of patients with chronic lymphocytic leukemia in the United States

Kabadi

Nagar

et al. 2019

Cancer Medicine

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Introduction Contemporary data describing treatment patterns, adverse events (AEs), and outcomes in patients with chronic lymphocytic leukemia (CLL) in clinical practice are lacking. We conducted a retrospective cohort study and assessed treatment patterns, AEs, health‐care resource use (HCRU), and costs in patients with diagnosis of CLL. Methods Using a nationally representative population of privately insured patients in the US, adult patients with CLL diagnosis (July 2012‐June 2015) were selected if they had continuous health plan enrollment for ≥12 months before the first CLL diagnosis without any evidence of any CLL‐directed treatment. Treatment patterns up to four lines of therapy (LOT) and occurrence of AEs during CLL therapies were assessed. Mean per‐patient monthly HCRU and costs were assessed overall and by number of unique AEs. Results Of all patients meeting the selection criteria (n = 7,639; median age, 66 years), 18% (n = 1,379) received a systemic therapy during study follow‐up. Of these, bendamustine/rituximab (BR) was the most common first observed regimen (28.1%), while ibrutinib was the most common therapy in the second (20.8%) and third (25.5%) observed regimens. The mean monthly all‐cause and CLL‐related costs, among patients treated with a systemic therapy, were $7,943 (SD = $15,757) and $5,185 (SD = $9,935), respectively. Mean monthly all‐cause costs increased by the number of AEs (from $905 [SD = $1,865] among those with no AEs to $6,032 [SD = $13,290] among those with ≥6 AEs). Conclusions Chemoimmunotherapy, particularly BR, was the most common first observed therapy for CLL, whereas ibrutinib was most preferred in the second and third observed lines of therapy during the study period. Findings demonstrate that the economic burden of AEs in CLL is substantial.

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“…To achieve equivalence to warfarin (Einstein Investigators, 2010, Agnelli et al, 2013 the peak anticoagulant effect of rivaroxaban could be higher than apixaban to accommodate the once daily dosing (Salem et al, 2015). Other evidence that bleeding risk may be greater with rivaroxaban than apixaban comes from two network meta-analysis of phase III RCTs, which provided indirect evidence of higher major bleeding risk for rivaroxaban versus apixaban, though precision was poor (Mantha & Ansell, 2015;Sterne et al, 2017), an observational study that did not restrict to the 6-month primary treatment period (Dawwas et al, 2019), comparisons conducted in the context of atrial fibrillation (Norby & Alonso, 2017), and the observation of increased menstrual bleeding with rivaroxaban versus apixaban (Myers & Webster, 2016).…”

Section: Comparison Of Apixaban Versus Rivaroxabanmentioning

confidence: 99%

Risk of hospitalised bleeding in comparisons of oral anticoagulant options for the primary treatment of venous thromboembolism

et al. 2019

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Summary Understanding of the comparative bleeding risks of oral anticoagulant (OAC) therapies for the primary treatment of venous thromboembolism (VTE) is limited. Therefore, among anticoagulant‐naïve VTE patients, we conducted comparisons of apixaban, rivaroxaban and warfarin on the rate of hospitalised bleeding within 180 days of OAC initation. MarketScan databases for the time‐period from 2011 to 2016 were used and, for each OAC comparison, new users were matched with up to five initiators of a different OAC. The final analysis included 83 985 VTE patients, who experienced 1944 hospitalised bleeding events. In multivariable‐adjusted Cox regression models, rate of hospitalised bleeding was lower among new users of apixaban when compared to new users of rivaroxaban [hazard ratio (95% confidence interval) 0·58 (0·41–0·80)] or warfarin [0·68 (0·50–0·92)]. Overall, the hospitalised bleeding rate was similar when comparing new users of rivaroxaban to new users of warfarin [0·98 (0·68–1·11)], though there was some suggestion that rivaroxaban was associated with lower bleeding risk among younger individuals. Findings from this large real‐world population concur with results from the randomised trial which found lower bleeding risk with apixaban versus warfarin and, for the first time, reveal a lower risk of bleeding in a comparison of apixaban versus rivaroxaban.

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Effectiveness and safety of apixaban versus rivaroxaban for prevention of recurrent venous thromboembolism and adverse bleeding events in patients with venous thromboembolism: a retrospective population-based cohort analysis

Cited by 66 publications

References 23 publications

Direct oral anticoagulants and warfarin for venous thromboembolism treatment: Trends from 2012 to 2017

Direct oral anticoagulants and warfarin for venous thromboembolism treatment: Trends from 2012 to 2017

Treatment patterns, adverse events, and economic burden in a privately insured population of patients with chronic lymphocytic leukemia in the United States

Risk of hospitalised bleeding in comparisons of oral anticoagulant options for the primary treatment of venous thromboembolism

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