Key result
Novel oral anticoagulant (NOAC) therapy in elderly NVAF patients had a 10.2% switch rate over 5 years, with rivaroxaban, apixaban, and edoxaban reducing switch risk by 44-68% versus dabigatran.
Why the study?
Although NOACs have emerged as prominent therapies in non-valvular atrial fibrillation, patterns of clinical burden, switching between all available NOACs, and dosage changes over 5 years required analysis in patients aged 70-75 years.
What are the incidence and predictors of switching and dose change of NOACs among elderly patients with NVAF?
Observational (n=4,640)
What are the incidence and predictors of switching and dose change of NOACs among elderly patients with NVAF?
In elderly patients with NVAF, switching NOACs or changing dosages occurs in about 20% over 5 years, with dabigatran having the highest switching rate.
Dabigatran linked to higher switching in elderly NVAF; leaves open optimal initial NOAC choice pending prospective data.
In the last decade, novel oral anticoagulants (NOACs) have emerged as prominent therapeutic options in non-valvular atrial fibrillation (NVAF). We analysed the clinical burden and the switching rate between all available NOACs, and their dosage change over a period of 5 years in a representative population of patients with NVAF aged between 70 and 75 years. Methods and Results: This is a retrospective observational study on administrative databases, covering approximately 6.2 million health-assisted individuals by the Italian National Health System (around 11% of the entire Italian residents). Out of 4640 NVAF patients treated with NOACs and aged 70-75 years in 2017, 3772 (81.3%) patients were still in treatment with NOAC up to 2021 and among them, 3389 (73.0%) patients remained in treatment with the same NOAC during 2017-2021. In fact, 10.2% of patients switched NOAC type and 10.3% changed the dose of the same NOAC. Overall, after switching, the dabigatran and rivaroxaban groups lost, respectively, 13.5% and 2.8% of patients, while apixaban and edoxaban resulted in a relative percentage increase of 6.8% and 44.6% of patients, respectively. By a logistic regression analysis, the treatment with rivaroxaban, apixaban, and edoxaban (respect to dabigatran) was associated with a significant risk reduction of switch of 57%, 68%, and 44%, respectively. On the other hand, several features of high risk were associated with dose reduction. Conclusions. In our 5-year analysis of a large administrative database, a switching among NOACs or a change in NOAC dosages occurred in around 20% of elderly patients with NVAF. The type of NOAC was associated with a high switching rate, while several characteristics of high risk resulted as predictors of dose reduction of NOACs. Moreover, a worsening trend of clinical conditions occurred in patients maintaining the same NOAC treatment across 2017-2021.
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Luca et al. (2023) conducted an observational in Nonvalvular Atrial Fibrillation (n=4,640). Novel oral anticoagulants (NOACs) vs. Dabigatran (for switching risk comparison) was evaluated on Switching NOAC type. Novel oral anticoagulant (NOAC) therapy in elderly NVAF patients had a 10.2% switch rate over 5 years, with rivaroxaban, apixaban, and edoxaban reducing switch risk by 44-68% versus dabigatran.
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