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Real world discontinuation among early users of apixaban, dabigatran, rivaroxaban or warfarin among atrial fibrillation patients newly initiated on anticoagulation therapy: tell of first 200 days
Purpose: This study evaluated discontinuation of apixaban, dabigatran, and rivaroxaban in the first 200 days after launch in patients with atrial fibrillation (AF) in the US real-world clinical practice setting.
Methods: A retrospective cohort study was conducted using MarketScan® including the Earlyview data. AF Patients >18 years (ICD-9 code 427.31 or 472.32) with one year of baseline period were included if they were newly prescribed the novel oral anticoagulants (NOACs) during the first 200 days after their availability in the US market, or newly prescribed warfarin after apixaban launch. Discontinuation was defined as lack of subsequent prescription of the index drug within 30 days after the last supply day of the last prescription. Cox proportional hazards model was used to compute hazard ratio (HR) of discontinuation, adjusting for potential confounders and other important patient characteristics.
Results: Among 17,356 eligible patients, 841 (4.85%) were initiated with apixaban, 5,805 (33.45%) with dabigatran, 2,125 (12.24%) with rivaroxaban and 8,585 (49.46%) with warfarin. The mean age of apixaban, dabigatran, rivaroxaban and warfarin patients were 70.3±12.0 years, 69.1±12.4 years, 69.2±12.1 years and 71.9±12.3 respectively. After adjusting baseline patient characteristics, apixaban was significantly less likely to discontinue versus rivaroxaban (HR: 0.60; CI: 0.48, 0.74) and warfarin (HR: 0.55, CI: 0.45 - 0.67) (Figure).
Conclusion: The risk of discontinuation was lower for apixaban versus rivaroxaban or warfarin among newly anticoagulated AF patients. These early findings with relatively short follow-up should be confirmed in future with larger sample size and longer term follow-up.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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