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Persistence and compliance amongst sacubitril/valsartan patients in germany, a retrospective cohort study from a longitudinal pharmacy database

Session Patient management - From oral treatment to transplant

Speaker Sara Bruce Wirta

Congress : Heart Failure 2018

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Rapid Fire Abstracts
  • FP Number : 1545

Authors : S Bruce Wirta (Stockholm,SE), R Wachter (Leipzig,DE), B Balas (Basel,CH), S Klebs (Nuremberg,DE), AF Fonseca (Basel,CH), CC Proenca (Basel,CH), M Dworak (Nuremberg,DE), R Schlienger (Basel,CH), J Engelhard (Frankfurt,DE), T Maier (Basel,CH), K Kostev (Frankfurt,DE)


S Bruce Wirta1 , R Wachter2 , B Balas3 , S Klebs4 , AF Fonseca5 , CC Proenca5 , M Dworak4 , R Schlienger3 , J Engelhard6 , T Maier3 , K Kostev6 , 1Novartis Sweden AB - Stockholm - Sweden , 2Universitätsklinikum Leipzig - Leipzig - Germany , 3Novartis Pharma AG - Basel - Switzerland , 4Novartis Pharma GmbH - Nuremberg - Germany , 5Wellmera AG - Basel - Switzerland , 6IQVIA - Frankfurt - Germany ,


Background: The angiotensin receptor neprilysin inhibitor sacubitril/valsartan (s/v) was launched in Germany in January 2016 for the treatment of symptomatic heart failure (HF) with reduced ejection fraction.

Purpose: To characterize compliance and persistence in s/v patients in real-world clinical practice.

Methods: Patients with at least one s/v prescription (Rx) between January 2016 and June 2017 and 12 months pre-index activity (defined by any Rx every 6 months) were identified in the German longitudinal pharmacy database (IMS LRx), covering approximately 60% of all dispensed Rx from public health insured patients. The date of the first Rx was defined as index. Days’ supply was defined as dispensed pack size/2, and discontinuation was defined as no new s/v Rx within 90 days after last days’ supply. Compliance was calculated as the proportion of days covered (PDC). Persistence was estimated with Kaplan-Meier (KM) plots, implementing definitions as above, and additionally censoring at end of study period or after a 90 days gap of no activity in the database (any Rx). A multi-variate Cox-regression model was used to assess the association between patient characteristics and persistence.

Results: A total of 22,275 adult patients (=18 years) fulfilled the inclusion criteria. S/v persistence at 12 months from index was 71%. Among non-persistent patients, the majority discontinued s/v within the first 90 days. Furthermore, persistence at 12 months was similar across different s/v doses at index, while time to discontinuation was shorter for 50 mg bid at index compared to 100 and 200 mg bid at index. Multivariate analysis revealed that younger age, male sex, a higher index dose of s/v, baseline use of HF therapy, oral diuretics, novel oral anticoagulants and lipid-lowering drugs showed significant associations with higher persistence. Compliance was assessed in a subset of patients with at least 12 months follow-up data, defined as a minimum of one s/v Rx each during 6 months post-index and 7-12 months post-index (N=8,226). High s/v compliance (PDC >80%) was observed. Compliance increased with the maximum dose reached by 6 months (PDC was 77% for 50 mg bid, 82% for 100 mg bid, and 85% for 200 mg bid). The same trend was observed for strata of s/v dose at index (PDC was 80% for 50 mg bid, 83% for 100 mg bid, and 85% for 200 mg bid).

Conclusion: Both persistence and compliance with s/v were high during the first year after index. The use of higher s/v dose was associated with increased compliance.

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