Shuk-Li Collings1, Virginie Vannier-Moreau2, Michelle E Johnson3, Gillian Stynes4, Cinira Lefèvre2, Andrew Maguire1, Joelle Asmar5, Geoffray Bizouard5, Didier Duhot6, Frédéric Mouquet7, Laurent Fauchier8. 1. OXON Epidemiology, Eastside, King's Cross, N1C 4AX London, UK. 2. Bristol-Myers Squibb, 92500 Rueil-Malmaison, France. 3. OXON Epidemiology, Eastside, King's Cross, N1C 4AX London, UK. Electronic address: michelle.johnson@oxonepi.com. 4. Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Uxbridge, Middlesex, UB8 1DH, UK. 5. IMS Health Information Solutions, 92773 Boulogne-Billancourt, France. 6. Département universitaire de médecine générale, SMBH université Paris 13, 93000 Bobigny, France. 7. Ramsay GDS, hôpital privé Le-Bois, 59000 Lille, France. 8. Centre hospitalier universitaire Trousseau et université François-Rabelais, 37000 Tours, France.
Abstract
BACKGROUND: Oral anticoagulants are prescribed in non-valvular atrial fibrillation for stroke prevention; however, little is known about the current management of anticoagulation in France, particularly given the availability of non-vitamin K antagonist oral anticoagulants in recent years. AIMS: To describe the characteristics of patients prescribed oral anticoagulants, and assess treatment persistence in French primary care. METHODS: We conducted a cohort study of patients with non-valvular atrial fibrillation, who were newly prescribed oral anticoagulants between 1 January 2014 and 31 January 2016, using French primary care data (IMS Longitudinal Patient Database). Adjusting for baseline characteristics, risk of non-persistence (switch or discontinuation) was compared using Cox regression. RESULTS: Of 4111 patients, 1710 were newly prescribed vitamin K antagonists, 1257 rivaroxaban, 744 apixaban and 400 dabigatran. The median age was 76 years, and 57.5% were male. History of hypertension was the most common co-morbidity (68.1%). Compared with vitamin K antagonists, non-persistence was higher with rivaroxaban (hazard ratio: 1.28; 95% confidence interval: 1.13-1.45) and dabigatran (hazard ratio: 1.42; 95% confidence interval: 1.20-1.69) and similar with apixaban (hazard ratio: 1.12; 95% confidence interval: 0.96-1.32). CONCLUSIONS: Non-persistence (treatment discontinuation or switch) with vitamin K antagonists was lower than with rivaroxaban and dabigatran in French primary care; however, non-persistence with the newest drug, apixaban, was similar to vitamin K antagonists. Larger studies with longer follow-up are needed to support these findings. This study is registered on ClinicalTrials.gov (NCT02488421).
BACKGROUND: Oral anticoagulants are prescribed in non-valvular atrial fibrillation for stroke prevention; however, little is known about the current management of anticoagulation in France, particularly given the availability of non-vitamin K antagonist oral anticoagulants in recent years. AIMS: To describe the characteristics of patients prescribed oral anticoagulants, and assess treatment persistence in French primary care. METHODS: We conducted a cohort study of patients with non-valvular atrial fibrillation, who were newly prescribed oral anticoagulants between 1 January 2014 and 31 January 2016, using French primary care data (IMS Longitudinal Patient Database). Adjusting for baseline characteristics, risk of non-persistence (switch or discontinuation) was compared using Cox regression. RESULTS: Of 4111 patients, 1710 were newly prescribed vitamin K antagonists, 1257 rivaroxaban, 744 apixaban and 400 dabigatran. The median age was 76 years, and 57.5% were male. History of hypertension was the most common co-morbidity (68.1%). Compared with vitamin K antagonists, non-persistence was higher with rivaroxaban (hazard ratio: 1.28; 95% confidence interval: 1.13-1.45) and dabigatran (hazard ratio: 1.42; 95% confidence interval: 1.20-1.69) and similar with apixaban (hazard ratio: 1.12; 95% confidence interval: 0.96-1.32). CONCLUSIONS: Non-persistence (treatment discontinuation or switch) with vitamin K antagonists was lower than with rivaroxaban and dabigatran in French primary care; however, non-persistence with the newest drug, apixaban, was similar to vitamin K antagonists. Larger studies with longer follow-up are needed to support these findings. This study is registered on ClinicalTrials.gov (NCT02488421).
Authors: Gilda Denise Zielinski; Nienke van Rein; Martina Teichert; Frederikus A Klok; Frits R Rosendaal; Felix J M van der Meer; Menno V Huisman; Suzanne C Cannegieter; Willem M Lijfering Journal: Res Pract Thromb Haemost Date: 2019-10-24