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CHANGES OVER TIME IN TREATMENT PERSISTENCE OF ORAL ANTICOAGULANTS IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION
769 JACC April 5, 2016 Volume 67, Issue 13
Arrhythmias and Clinical EP CHANGES OVER TIME IN TREATMENT PERSISTENCE OF ORAL ANTICOAGULANTS IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: Can We Do Better With Atrial Fibrillation Ablation? Abstract Category: 16. Arrhythmias and Clinical EP: AF/SVT Presentation Number: 1154-359 Authors: Cinira Lefevre, Michelle Johnson, Shuk-Li Collings, David Evans, Sebastian Kloss, Essra Ridha, Andrew Maguire, Bristol-Myers Squibb, France, France
Background: Oral anticoagulants (OACs) reduce thromboembolic stroke risk in patients with atrial fibrillation, thus it is critical patients stay on treatment. Vitamin K antagonists (VKA) requires monitoring after initiation whereas novel OACs do not. If monitoring increases chances of staying on treatment, this would create differences in the comparative persistence across OACs over time. We compared changes over time in treatment persistence to OACs (VKA, apixaban, dabigatran and rivaroxaban) in patients with non-valvular atrial fibrillation (NVAF). Methods: Retrospective cohort study of patients with NVAF newly treated with OACs (index prescription) between 2012 and 2014 from the UK Clinical Practice Research Datalink (CPRD). We followed patients from index OAC prescription until first of treatment switch/ discontinuation, death, transfer out of practice, or end of study period. In OAC-naïve and experienced patients, we ran separate Cox regressions to compare time to non-persistence partitioning follow-up by the first 2 months vs. 2 months onwards after OAC initiation and reported hazard ratios with 95% confidence intervals, adjusting for demographics, OAC-experience, baseline comorbidities and concomitant therapies.
Results: Overall, 782 patients initiated apixaban, 1,385 dabigatran, 2,593 rivaroxaban and 9,303 warfarin in the study period. In the first 2 months, patients on rivaroxaban and dabigatran were 17% (1.17;0.91-1.50) and 56% (1.56;1.20-2.03) more likely to be non-persistent, as compared to apixaban patients; while patients on warfarin were 72% less likely to be non-persistent (0.28;0.21-0.37). After 2 months, patients on rivaroxaban, dabigatran or warfarin were more likely to be non-persistent, compared to patients initiating apixaban [1.69 (1.192.39), 2.32 (1.63-3.31) and 1.81 (1.30-2.53) respectively]. Conclusions: Real-world changes over time in OACs treatment persistence were particularly important when comparing warfarin vs. apixaban, with a reversal from better to worse persistence between the earlier to the later period. Future analyses should consider timevarying patterns, especially for VKA, when investigating real-world use of OACs.
Arrhythmias and Clinical EP CHANGES OVER TIME IN TREATMENT PERSISTENCE OF ORAL ANTICOAGULANTS IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: Can We Do Better With Atrial Fibrillation Ablation? Abstract Category: 16. Arrhythmias and Clinical EP: AF/SVT Presentation Number: 1154-359 Authors: Cinira Lefevre, Michelle Johnson, Shuk-Li Collings, David Evans, Sebastian Kloss, Essra Ridha, Andrew Maguire, Bristol-Myers Squibb, France, France
Background: Oral anticoagulants (OACs) reduce thromboembolic stroke risk in patients with atrial fibrillation, thus it is critical patients stay on treatment. Vitamin K antagonists (VKA) requires monitoring after initiation whereas novel OACs do not. If monitoring increases chances of staying on treatment, this would create differences in the comparative persistence across OACs over time. We compared changes over time in treatment persistence to OACs (VKA, apixaban, dabigatran and rivaroxaban) in patients with non-valvular atrial fibrillation (NVAF). Methods: Retrospective cohort study of patients with NVAF newly treated with OACs (index prescription) between 2012 and 2014 from the UK Clinical Practice Research Datalink (CPRD). We followed patients from index OAC prescription until first of treatment switch/ discontinuation, death, transfer out of practice, or end of study period. In OAC-naïve and experienced patients, we ran separate Cox regressions to compare time to non-persistence partitioning follow-up by the first 2 months vs. 2 months onwards after OAC initiation and reported hazard ratios with 95% confidence intervals, adjusting for demographics, OAC-experience, baseline comorbidities and concomitant therapies.
Results: Overall, 782 patients initiated apixaban, 1,385 dabigatran, 2,593 rivaroxaban and 9,303 warfarin in the study period. In the first 2 months, patients on rivaroxaban and dabigatran were 17% (1.17;0.91-1.50) and 56% (1.56;1.20-2.03) more likely to be non-persistent, as compared to apixaban patients; while patients on warfarin were 72% less likely to be non-persistent (0.28;0.21-0.37). After 2 months, patients on rivaroxaban, dabigatran or warfarin were more likely to be non-persistent, compared to patients initiating apixaban [1.69 (1.192.39), 2.32 (1.63-3.31) and 1.81 (1.30-2.53) respectively]. Conclusions: Real-world changes over time in OACs treatment persistence were particularly important when comparing warfarin vs. apixaban, with a reversal from better to worse persistence between the earlier to the later period. Future analyses should consider timevarying patterns, especially for VKA, when investigating real-world use of OACs.