Rivaroxaban was associated with significantly better medication persistence compared to warfarin (HR 0.62) and dabigatran (HR 0.64) in patients with non-valvular atrial fibrillation.
Cohort (n=32,634)
Does rivaroxaban improve medication persistence and reduce discontinuation compared to dabigatran and warfarin in patients with non-valvular atrial fibrillation?
In real-world practice, newly initiated rivaroxaban is associated with significantly higher treatment persistence and lower discontinuation rates compared to dabigatran and warfarin in patients with non-valvular atrial fibrillation.
Hazard Ratio: 0.62 (95% CI 0.59–0.64)
A retrospective cohort analysis of the US MarketScan claims databases was performed to compare persistence and discontinuation rates between the vitamin K antagonist warfarin and the non-vitamin K antagonist oral anticoagulants rivaroxaban and dabigatran in patients with non-valvular atrial fibrillation. The analysis included adult patients with non-valvular atrial fibrillation newly initiated on rivaroxaban, dabigatran, or warfarin between November 1, 2011 and December 31, 2013, with a baseline CHA2DS2-VASc score ≥2, two or more non-valvular atrial fibrillation diagnosis codes (427.31), and ≥6 months' continuous medical and pharmacy benefit enrollment before oral anticoagulant initiation. Propensity score matching was performed to match patients receiving rivaroxaban with those receiving dabigatran (1:1) and warfarin (1:1). Patients were followed until the first event of inpatient death, end of continuous enrollment, or end of study period. Medication persistence was defined as absence of a refill gap of >60 days. Discontinuation was defined as no additional refill for >90 days and through to end of follow-up. Hazard ratios (HRs) of oral anticoagulant persistence and discontinuation were estimated using Cox proportional hazard models. In total, 3,2634 patients were included (n = 10878/oral anticoagulant group). Rivaroxaban was associated with better persistence than both dabigatran (HR 0.64, 95% confidence interval CI 0.62-0.67) and warfarin (HR 0.62, 95% CI 0.59-0.64) and lower discontinuation than dabigatran (HR 0.61, 95% CI 0.58-0.64) and warfarin (HR 0.65, 95% CI 0.62-0.68). Real-world analysis of oral anticoagulant use may reveal whether the relatively high persistence/low discontinuation demonstrated for rivaroxaban translates into lower rates of stroke.
Coleman et al. (Tue,) conducted a cohort in Non-valvular atrial fibrillation (n=32,634). Rivaroxaban vs. Warfarin and Dabigatran was evaluated on Medication persistence (absence of a refill gap of >60 days) (HR 0.62, 95% CI 0.59-0.64). Rivaroxaban was associated with significantly better medication persistence compared to warfarin (HR 0.62) and dabigatran (HR 0.64) in patients with non-valvular atrial fibrillation.