Comparison of Treatment Persistence with Dabigatran or Rivaroxaban versus Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients: A Competing Risk Analysis in the French National Health Care Databases

Maura, Géric; Billionnet, Cécile; Alla, François; Gagne, Joshua J.; Pariente, Alexandre

doi:10.1002/phar.2046

Cited by 27 publications

(20 citation statements)

References 54 publications

(123 reference statements)

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“…The high non‐persistence rates of DOAC use amongst patient with atrial fibrillation found in our study (34% for DOACs, 26% for apixaban, 27% for dabigatran and 42% for rivaroxaban, all at 1 year) were comparable to the non‐persistence found in other observational studies of patients using either VKA or DOACs after 1 year in which close patient monitoring was lacking. Neither Germany or France have specialized anticoagulant clinics to monitor VKA users.…”

Section: Discussionsupporting

confidence: 74%

“…When we compare our results to other observational studies, one striking feature is the wide variety in reported non‐persistence of oral anticoagulant use amongst atrial fibrillation patients (Figure ). However, we could identify one common characteristic for the non‐persistence rates found in our and other observational studies for oral anticoagulants, which was whether or not patients were monitored on oral anticoagulant drugs.…”

Section: Discussionsupporting

confidence: 47%

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Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski

Rein

Teichert

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: In contrast to vitamin K antagonists (VKA), direct oral anticoagulants (DOAC's) are not strictly monitored and dose titrated by anticoagulation clinics in the Netherlands. This may affect drug persistence of atrial fibrillation (AF) patients, whom often require lifelong treatment.Objectives: To assess persistence of DOACs and of VKAs in patients with AF.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionsupporting

confidence: 47%

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski

Rein

Teichert

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…A smaller study by Martinez et al 12 reported much lower NOAC discontinuation rates to ours (17% at 1 year) with apixaban unable to be assessed due to short duration of available follow-up (apixaban was recommended by the UK National Institute for Health and Care Excellence guidelines a year later than for dabigatran and rivaroxaban) 29–31. Studies from other European countries have reported either highly comparable,32 notably higher17 or lower15 18 1-year NOAC discontinuation rates based on a 30-day treatment gap,18 60-day treatment gap17 32 or other definition of discontinuation,15 with differences possibly attributable to differences in study size, design and/or composition of the study population (eg, the inclusion of OAC-naïve users only). One-year NOAC discontinuation rates among patient populations with NVAF reported from claims database studies in USA have been substantially higher,21 33 yet are consistent with a trend of higher discontinuation for dabigatran compared with rivaroxaban or apixaban,13 15 17 21 22 32 33 and of rates lowest for apixaban in most,13 15 17 21 33 although not all,22 studies.…”

Section: Discussionmentioning

confidence: 99%

“…Switching rates among other European NVAF cohorts starting NOAC therapy have been notably higher. In particular, using national healthcare databases in France, Maura et al 32 found that 9.8% of patients starting rivaroxaban therapy switched to another OAC class, while in the UK, Martinez et al 12 reported a 6.6% NOAC-to-VKA switch rate.…”

Section: Discussionmentioning

confidence: 99%

Discontinuation of non-Vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: a population-based cohort study using primary care data from The Health Improvement Network in the UK

et al. 2019

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ObjectiveTo determine discontinuation rates, patterns of use and predictors of discontinuation of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with non-valvular atrial fibrillation (NVAF) in the first year of therapy.DesignPopulation-based cohort study.SettingUK primary care.Population11 481 patients with NVAF and a first prescription (index date) for apixaban, dabigatran or rivaroxaban (January 2012 to December 2016) with at least 1 year of follow-up and at least one further NOAC prescription in the year following the index date were identified. 1 year rates and patterns of discontinuation were described.Primary and secondary outcome measuresOutcome measures were the percentage of patients who, in the first year from starting NOAC therapy, discontinued with their oral anticoagulant (OAC) therapy (discontinuation was defined as a gap in OAC therapy of >30 days); switched OAC within 30 days; discontinued and reinitiated OAC therapy. Predictors of discontinuation were also evaluated.Results1 year discontinuation rates according to the index NOAC were 26.1% for apixaban, 40.0% for dabigatran and 29.6% for rivaroxaban. Reinitiation rates were 18.1% for apixaban, 21.7% for dabigatran and 17.3% for rivaroxaban, and switching rates were 2.8% for apixaban, 8.8% for dabigatran and 4.9% for rivaroxaban. More than 93% of reinitiations were with the index NOAC. Patients starting on dabigatran were more likely to switch OAC therapy than those starting on apixaban; ORs 4.28 (95% CI 3.24 to 5.65) for dabigatran and 1.89 (95% CI 1.49 to 2.39) for rivaroxaban. Severely reduced renal function was a predictor of any discontinuation, OR 1.77 (95% CI 1.28 to 2.44).ConclusionWhile the majority of patients with NVAF in the UK initiating NOAC treatment received continuous therapy in the first year of treatment, a substantial proportion of patients experienced gaps in treatment leaving them less protected against thromboembolism during these periods.

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“…The level of utilization of the different DOAC in stroke prevention in NVAF has shown to be different among countries, and several cohort studies have shown dissimilar results on effectiveness and safety of these drugs [5][6][7][8][9][10][11][12]. Adequate levels of adherence and persistence to anticoagulant treatment have shown to decrease the occurrence of embolic events [13][14][15][16], so other studies have assessed adherence and persistence to oral anticoagulants (OAC), also showing different results among them [17][18][19][20][21][22][23]. Adherence has been defined as the extent to which the patient conforms to the medication use recommendations specified by the prescriber (frequency of administration, dosage, etc.…”

Section: Introductionmentioning

confidence: 99%

The use and adherence of oral anticoagulants in Primary Healthcare in Catalunya: a real-world data cohort study

Soriano

Martínez

Lumbreras

et al. 2019

Preprint

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Background The use of direct oral anticoagulants (DOAC) for stroke prevention in non-valvular atrial fibrillation (NVAF) has not been previously assessed in our setting. We aimed to describe sociodemographic, comorbidities, co-medication and risk of thromboembolic events and bleeding in patients with NVAF initiating oral anticoagulants (OAC) for stroke prevention, and to estimate adherence and persistence to OAC.Methods Population-based cohort study including all NVAF adult patients initiating OAC for stroke prevention in August 2013-December 2015. Persistence was measured in patients initiating OAC in August 2013-December 2014. Data source is SIDIAP, which captures electronic health records from Primary Health Care in the Catalan Health Institute, covering approximately 5.8 million people.Results 51,690 NVAF patients initiated OAC; 47,197 (91.3%) were naive to OAC and 32,404 initiated acenocoumarol (62.7%). Mean age was 72.8 years (SD 12.3) and 49.4% were women. Platelet-aggregation inhibitors were taken by 9,105 (17.6%) of the patients. For 22,075 patients, persistence was higher among the non-naive patients [n=258 (61.7%)] than among the naive [n=11,502 (53.1%)]. Adherence was estimated for patients initiating DOAC and was similar in naive and non-naive patients. Among the naive to DOAC treatment, those starting rivaroxaban showed a highest proportion [(n=360 (80.1%)] of good adherence at implementation (MPR>80%) while patients starting dabigatran were less adherent [n= 203 47.8%)].Conclusions Acenocoumarol was the most frequently prescribed OAC as first therapy in NVAF patients. Non-naive to DOAC showed better persistence than naive. Rivaroxaban showed higher proportion of adherent patients during the implementation phase than apixaban and dabigatran the lowest.

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Comparison of Treatment Persistence with Dabigatran or Rivaroxaban versus Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients: A Competing Risk Analysis in the French National Health Care Databases

Cited by 27 publications

References 54 publications

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Discontinuation of non-Vitamin K antagonist oral anticoagulants in patients with non-valvular atrial fibrillation: a population-based cohort study using primary care data from The Health Improvement Network in the UK

The use and adherence of oral anticoagulants in Primary Healthcare in Catalunya: a real-world data cohort study

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