Key result
Rivaroxaban linked to ~24% lower likelihood of expected trough levels vs apixaban in Asian patients.
Why the study?
This study was conducted to measure rivaroxaban and apixaban plasma levels in Asian patients with atrial fibrillation and compare them with expected drug levels from clinical studies.
Does rivaroxaban compared to apixaban result in different rates of out-of-expected plasma drug levels in Asian patients with atrial fibrillation?
Observational (n=178)
Does rivaroxaban compared to apixaban result in different rates of out-of-expected plasma drug levels in Asian patients with atrial fibrillation?
Absolute Event Rate: 64.4% vs 84.8%
p-value: p=0.002
In Asian patients with atrial fibrillation, real-world plasma levels of rivaroxaban are more frequently outside the expected therapeutic range compared to apixaban.
Out-of-range levels more common with rivaroxaban in Asian AF; hypothesis-generating and should not yet change practice.
This study aims to measure the plasma levels of rivaroxaban and apixaban among Asian patients with atrial fibrillation and compare the results with expected drug levels from clinical studies. A total of 73 patients taking rivaroxaban and 105 patients taking apixaban were enrolled. Peak and trough levels were measured using ultra-high performance liquid chromatography with tandem mass spectrometry. The percentage of those with drug levels within the expected range reported in clinical studies was significantly higher in the apixaban group than in the rivaroxaban group, both for trough (84.8% vs. 64.4%; P = 0.002) and peak levels (76.9% vs. 33.8%; P < 0.001). After adjusting for age, sex, kidney function, appropriate dose, and adherence, patients taking rivaroxaban were still less likely to have peak and trough levels within the expected drug levels. Our real-world data suggests that Asian patients taking rivaroxaban are more likely to have out-of-expected drug levels than those taking apixaban.
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Lin et al. (2019) conducted an observational in Atrial fibrillation (n=178). Rivaroxaban vs. Apixaban was evaluated on Percentage of patients with trough drug levels within the expected range (p=0.002). Asian patients taking rivaroxaban were significantly less likely to have trough (64.4% vs. 84.8%; P=0.002) and peak (33.8% vs. 76.9%; P<0.001) drug levels within expected ranges than those on apixaban.
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