Key result
Apixaban users were the most likely to have high adherence at 12 months compared to dabigatran (OR 1.73) and rivaroxaban (OR 1.24), despite a twice-daily dosing schedule.
Why the study?
DOAC adherence in NVAF is critical to maintain effectiveness, but whether differences in adherence relate to drug properties such as dosing interval remained unclear.
Does apixaban improve medication adherence compared to rivaroxaban and dabigatran in patients with newly diagnosed nonvalvular atrial fibrillation?
Cohort (n=38,947)
Does apixaban improve medication adherence compared to rivaroxaban and dabigatran in patients with newly diagnosed nonvalvular atrial fibrillation?
Odds Ratio: 1.73 (95% CI 1.6–1.88)
Absolute Event Rate: 56.26% vs 40.73%
p-value: p=<0.05
In a real-world cohort of NVAF patients, apixaban was associated with the highest overall adherence at 12 months compared to rivaroxaban and dabigatran, suggesting that dosing frequency (twice-daily vs. once-daily) is not the sole determinant of medication adherence.
Apixaban may support adherence-focused NOAC selection in practice; leaves open whether dosing frequency drives persistence in prospective studies.
BACKGROUND: Differences in adherence may represent drug properties (e.g. dosing interval) or patient experiences while on treatment. Adherence to direct oral anticoagulants (DOACs) in nonvalvular atrial fibrillation (NVAF) is important to maintain effectiveness over the course of treatment. METHODS: This was a retrospective cohort study using 2009-2015 Truven Health MarketScan Databases. New initiators of dabigatran, rivaroxaban, and apixaban with NVAF were identified. Twelve months of continuous enrollment before treatment was required to assess demographics and medical history. Proportion of days cover (PDC) was used to measure adherence at 3, 6, 9 and 12-month. Gaps in therapy and treatment switches were also evaluated. Logistic regression was used to compare high adherence (PDC ≥0.80). RESULTS: A total of 14,864 dabigatran, 16,005 rivaroxaban, and 8078 apixaban users were identified. Apixaban users had the highest adherence overall, with mean PDC at 3, 6, 9, and 12-months of 0.83, 0.76, 0.72, and 0.69, while dabigatran had the lowest adherence of 0.78, 0.67, 0.61, and 0.57. Adherence to DOACs increased with increased stroke risk scores. Adherence was also higher when first days supplied was > 30 days compared to 30 days and when filled via mail order pharmacies. Switching was highest among dabigatran users. Apixaban users were the most likely to have high adherence versus dabigatran (OR = 1.73, 95% CI = 1.60-1.88) and versus rivaroxaban (OR = 1.24, 95% CI = 1.14-1.34) at 12-months. CONCLUSIONS: Apixaban users had the highest overall adherence despite twice-daily dosing versus once-daily dosing for rivaroxaban. These findings can be useful for formulary decision-making and when assessing treatment options.
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Pham et al. (2019) conducted a cohort in Nonvalvular atrial fibrillation (n=38,947). Apixaban vs. Dabigatran was evaluated on High adherence (Proportion of days covered ≥0.80) at 12 months (OR 1.73, 95% CI 1.60-1.88, p=<0.05). Apixaban users were the most likely to have high adherence at 12 months compared to dabigatran (OR 1.73) and rivaroxaban (OR 1.24), despite a twice-daily dosing schedule.
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