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Open Access 03-05-2023 | Dabigatran | Original Research

Anticoagulant Treatment Adherence and Persistence in German Patients with Atrial Fibrillation

Authors: Giuseppe Patti, Rosa Wang, Xiaocong Li Marston, Yu-Chen Yeh, Lisa Zimmermann, Xin Ye, Xin Gao, Bernd Brüggenjürgen

Published in: Cardiology and Therapy | Issue 2/2023

Abstract

Introduction

Treatment adherence and persistence impact the effectiveness of edoxaban for the prevention of thromboembolism in patients with atrial fibrillation (AF). The objective of this analysis was to assess adherence and persistence of edoxaban vs. other non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs).

Methods

Utilizing a German claims database, adults with AF with the first pharmacy claim identified for edoxaban, apixaban, dabigatran, rivaroxaban, or VKAs from January 2013 to December 2017 were included in a propensity score-matched analysis. The first pharmacy claim was the index claim. Adherence (i.e., proportion of days covered [PDC]) and persistence (proportion of patients who continued therapy) were compared between edoxaban and other therapies. Patients receiving once-daily (QD) vs. twice-daily (BID) NOAC were also analyzed.

Results

Overall, 21,038 patients were included (1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA). After matching, baseline characteristics were well balanced across cohorts. Adherence was significantly higher for edoxaban vs. apixaban, dabigatran, and VKAs (all P < 0.0001). Significantly more edoxaban patients continued therapy vs. rivaroxaban (P = 0.0153), dabigatran (P < 0.0001), and VKAs (P < 0.0001). Time to discontinuation was significantly longer for edoxaban vs. dabigatran, rivaroxaban, and VKAs (all P < 0.0001). More patients receiving NOACs QD had a PDC ≥ 0.8 compared with those receiving NOACs BID (65.3 vs. 49.6%, respectively; P < 0.05); persistence rates were comparable between QD and BID groups.

Conclusions

Patients with AF receiving edoxaban had significantly higher adherence and persistence compared with those receiving VKAs. This trend was also seen in NOAC QD regimens vs. NOAC BID regimens for adherence. These results provide insight into how adherence and persistence may contribute to the effectiveness of edoxaban for stroke prevention in patients with AF in Germany.

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Title: Anticoagulant Treatment Adherence and Persistence in German Patients with Atrial Fibrillation
Authors: Giuseppe Patti
Rosa Wang
Xiaocong Li Marston
Yu-Chen Yeh
Lisa Zimmermann
Xin Ye
Xin Gao
Bernd Brüggenjürgen
Publication date: 03-05-2023
Publisher: Springer Healthcare
Keywords: Dabigatran
Edoxaban
Anticoagulant
Oral Anticoagulant
Atrial Fibrillation
Apixaban
Rivaroxaban
Published in: Cardiology and Therapy / Issue 2/2023
Print ISSN: 2193-8261
Electronic ISSN: 2193-6544
DOI: https://doi.org/10.1007/s40119-023-00315-8

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