Key result
Edoxaban associated with ~97% higher 1-year mortality vs rivaroxaban in AF, potentially confounded by age.
Why the study?
The study was conducted to assess the efficacy and safety of treatment with edoxaban or rivaroxaban for stroke prevention in patients with atrial fibrillation.
Does edoxaban compared to rivaroxaban improve efficacy and safety outcomes in patients with atrial fibrillation in a real-world setting?
Meta-Analysis (n=19,876)
None
Yes
Does edoxaban compared to rivaroxaban improve efficacy and safety outcomes in patients with atrial fibrillation in a real-world setting?
Effect estimate: OR 1.97 (95% CI 1.61 to 2.42)
Absolute Event Rate: 3.5% vs 1.7%
p-value: p=<0.00001
In a pooled analysis of two real-world cohorts, rivaroxaban was associated with lower unadjusted rates of mortality and bleeding compared to edoxaban, though significant baseline differences and high heterogeneity limit definitive conclusions.
Caution advised against switching agents based on unadjusted data; leaves open whether edoxaban increases mortality versus rivaroxaban after adjustment.
Background: This study aims to assess the efficacy and safety of treatment with edoxaban or rivaroxaban for stroke prevention in patients with atrial fibrillation. Methods: Pooled analysis from two real-world cohorts. Efficacy outcomes were all-cause mortality, cardiovascular mortality and thromboembolic events at 1 year. Safety outcomes were assessed by major or nonmajor bleeding. Results: A total of 19876 patients were enrolled in both trials. All-cause mortality at 1 year was lower in the rivaroxaban group (118 of 6784 patients [1.7%]) than in the edoxaban group (442 of 13092 patients [3.5%]) (unadjusted odds ratio was 1.97 (95% CI, 1.61 to 2.42; P=<0.00001). Cardiovascular mortality was edoxaban (206 of 13092 patients [1.63%]) vs rivaroxaban 49 of 6784 patients [0.72%]) (unadjusted OR, 2.20; 95% CI, 1.61 to 3.00; p=<0.00001). Overall, the efficacy outcomes favoured the rivaroxaban cohort (OR 1.97, 95% CI, 1.33 to 2.91; P=0.0002), with no significant difference in ischaemic stroke between the two cohorts (unadjusted OR 1.13, 95% CI, 0.75 to 1.73; P=0.56). Overall, safety outcomes tended to occur more often in the edoxaban cohort (unadjusted OR 0.43, 95% CI, 0.20 to 0.40; P=<0.00001). Conclusion: Rivaroxaban and edoxaban seem to be effective and safe. However, real-world prospective studies evaluating safety and efficacy in certain subgroups are needed.
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Ferreira et al. (2021) conducted a meta-analysis in Atrial Fibrillation (n=19,876). Edoxaban vs. Rivaroxaban was evaluated on All-cause mortality at 1 year (OR 1.97, 95% CI 1.61 to 2.42, p=<0.00001). Edoxaban was associated with a higher rate of all-cause mortality at 1 year compared to rivaroxaban in patients with atrial fibrillation (3.5% vs 1.7%, OR 1.97), though this may be confounded by the older age of the edoxaban cohort.
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