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Treatment persistence of patients with atrial fibrillation on VKA or NOAC: Data from GLORIA-AF Phase III 1-year interim analysis

Session Poster Session 5

Speaker Gregory Yh Lip

Event : ESC Congress 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Oral Anticoagulation
  • Session type : Poster Session

Authors : GYH Lip (Liverpool,GB), H-C Diener (Duisberg,DE), SJ Dubner (Caba,AR), JL Halperin (New York,US), KJ Rothman (Durham,US), C-S Ma (Beijing,CN), S Lu (Ridgefield,US), M Paquette (Burlington,CA), L Riou Franca (Ingelheim am Rhein,DE), K Zint (Ingelheim am Rhein,DE), C Teutsch (Ingelheim am Rhein,DE), MV Huisman (Leiden,NL)

Authors:
G.Y.H. Lip1 , H.-C. Diener2 , S.J. Dubner3 , J.L. Halperin4 , K.J. Rothman5 , C.-S. Ma6 , S. Lu7 , M. Paquette8 , L. Riou Franca9 , K. Zint9 , C. Teutsch9 , M.V. Huisman10 , 1University of Liverpool, Institute of Cardiovascular Science - Liverpool - United Kingdom , 2University of Duisburg-Essen - Duisberg - Germany , 3Clínica y Maternidad Suizo Argentina - Caba - Argentina , 4Icahn School of Medicine at Mount Sinai - New York - United States of America , 5RTI Health Solutions, Research Triangle Institute - Durham - United States of America , 6Beijing Anzhen Hospital - Beijing - China , 7Boehringer Ingelheim Pharmaceuticals, Inc - Ridgefield - United States of America , 8Boehringer Ingelheim - Burlington - Canada , 9Boehringer Ingelheim International - Ingelheim am Rhein - Germany , 10Leiden University Medical Center - Leiden - Netherlands (The) ,

On behalf: The GLORIA-AF Registry investigators and patients

Topic(s):
Oral Anticoagulation

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 2987

Background: Oral anticoagulation (OAC) persistence is important for optimizing stroke prevention in patients with atrial fibrillation (AF); non-vitamin K oral anticoagulants (NOACs) generally show better persistence than vitamin K antagonists (VKAs), while the impact of dosing regimens remains unclear. We compared treatment persistence of NOACs and VKAs, and of NOAC dosing regimens in the prospective GLORIA-AF registry program.

Methods: Patients newly diagnosed with AF were enrolled in Phase III of GLORIA-AF (2014–2016) from 4 geographical regions (North America [NA], Europe, Asia and Latin America). Treatment persistence after 1 year for i) NOAC (dabigatran, rivaroxaban, apixaban, edoxaban) vs VKA, and ii) twice daily (bid, dabigatran, apixaban) vs once daily (od; rivaroxaban, edoxaban) NOAC treatment was analysed using multivariable Cox analysis; propensity score trimming was used to reduce bias due to unmeasured confounders. Missing data was handled by multiple imputation.

Results: Overall, 21,592 patients were enrolled (4970 [23%] patients on VKAs, 12,797 [59%] on NOACs, 2391 [11%] on antiplatelets, and 1426 [6.6%] received no therapy; 8 [0.04%] received other treatment). After trimming, 11,935 and 4484 patients treated with NOACs and VKAs, respectively, were compared. NOACs had better treatment persistence than VKAs (discontinuation hazard ratio [HR]=0.75, 95% confidence interval [CI] 0.69–0.81). Other relevant associations were decreased OAC persistence for symptomatic AF, NA and Asia regions (Table). There was no difference in treatment persistence for patients on a bid (N=7842) vs od (N=4098) NOAC (discontinuation HR=0.94, 95% CI 0.86–1.02).

Conclusion: In this 1-year interim analysis of GLORIA-AF Phase III, treatment persistence was improved with NOACs vs VKAs, whereas for NOACs, dosing regimen (bid vs od) had no impact on treatment persistence.

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