Comparative non-persistence in the first year of treatment with oral anticoagulants in patients with atrial fibrillation: A French comprehensive nationwide study - 02/12/22
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Highlights |
• | Discontinuation rates of all initial DOACs used were high. |
• | Non-persistence was lower with apixaban versus VKAs, rivaroxaban and dabigatran. |
• | Only a minority of those who discontinued a given OAC switched to another one. |
Abstract |
Background |
Direct oral anticoagulants (DOACs) were developed as an alternative to vitamin K antagonists (VKAs) and are commonly used for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Unlike VKAs, DOACs do not require Internal Normalized Ratio (INR) monitoring, but regular intake is as important for effective anticoagulation.
Objectives |
This study examined treatment persistence among patients receiving oral anticoagulants (OACs) for NVAF.
Methods |
Within the French healthcare claims database (SNDS), we assessed and compared the rates of non-persistence (≥ 30-day treatment gap) among patients with NVAF initiating an OAC between January 2014 and December 2016. The time-to-event of non-persistence was computed and plotted using a cumulative incidence function accounting for the competing risk of mortality. After adjusting on confounding factors, the risk for non-persistence was compared between apixaban and each other OACs using a Cox proportional hazard model, or Fine and Gray models.
Results |
In a cohort of 321,501 OAC-naive patients with NVAF, the cumulative incidence of non-persistence at 12 months considering competing risk was 44.3%, 31.0%, 41.3% and 46.8% for VKAs, apixaban, rivaroxaban and dabigatran, respectively. Median therapy duration before non-persistence ranged between 70 and 121 days. Non-persistence was lower with apixaban compared with VKAs (HR=0.63, 95%CI=[0.62–0.64]), rivaroxaban (HR=0.71, 95%CI=[0.70–0.73]), and dabigatran (HR=0.60, 95%CI=[0.59–0.62]).
Conclusions |
In this nationwide observational study, non-persistence rates of oral anticoagulant treatment were high in patients treated for NVAF. Apixaban-treated patients seem to experience lowest discontinuation rates 12 months after treatment initiation compared to patients treated with any other OAC.
Le texte complet de cet article est disponible en PDF.Keywords : Anticoagulants, Persistence, Drug utilization, Claims analysis, Observational study
Abbreviations : AC, AF, BMI, CI, DOAC, HR, INR, NHS, NVAF, OAC, SNDS, STE, VKA
Plan
Vol 115 - N° 11
P. 571-577 - novembre 2022 Retour au numéro
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