Improved adherence to anticoagulant therapy with once-daily regimen: a real-world study in patients with atrial fibrillation in Germany

Abstract

Abstract Background Adherence and persistence to non-VKA oral anticoagulants (NOACs) are important to achieve optimal clinical outcomes in patients with atrial fibrillation (AF). Dosing frequency may play a role in adherence and persistence to NOAC therapy. Among the NOACs that are currently available, edoxaban and rivaroxaban are given once daily (QD) while dabigatran and apixaban are given twice daily (BID). Purpose The objective of the study was to compare the adherence and persistence in AF patients receiving QD versus BID NOAC regimens in Germany. Methods Using an administrative database from our institution (Deutsche Analysedatenbank für Evaluation und Versorgungsforschung) between January 2013 and December 2017, a retrospective cohort study was conducted to compare the 6-month adherence in NOAC-naïve AF patients who initiated anticoagulant therapy. Continuous enrolment for 12 months before anticoagulant initiation was required to assess baseline characteristics. Adherence was measured using proportion of days covered (PDC) and medication possession ratio (MPR). Proportions of patients with PDC ≥80% and MPR ≥80% were also measured. Treatment discontinuation was defined as a prescription supply gap of ≥90 days. Inverse probability treatment weighting using propensity score was applied to control for differences in baseline characteristics. Results A total of 8249 (1236 edoxaban, 7013 rivaroxaban) and 7359 (6053 apixaban, 1306 dabigatran) patients who received QD and BID regimens were included. The two regimen groups were well balanced after weighting. Patients who received QD regimens had a significantly higher mean PDC at 6 months compared to those who received BID regimens (0.78 vs. 0.72, p<0.05). The proportion of patients with PDC ≥80% was significantly higher for QD versus BID regimens (65.3% vs. 49.6%, p<0.05). Similarly, the mean MPR was higher for QD versus BID regimens (0.81 vs. 0.74, p<0.05), with more QD patients having MPR ≥80% than BID patients (69.5% vs. 53.3%, p<0.05). Six-month persistence rates were comparable between the two regimen groups (73.4% vs. 74.2%, p=0.13). Conclusions Adherence to once-daily regimens of NOAC was significantly higher compared to adherence to twice-daily NOAC regimens. Future research is needed to examine the relationship between adherence to NOAC treatment and clinical outcomes in AF patients, and factors affecting persistence. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This study was sponsored by Daiichi Sankyo Inc