Sola Han1, Hae Sun Suh2, Myung-Yong Lee3, Oh Young Bang4, Young Keun On5, Sung-Won Jang6, Seongwook Han7, Jaeyun Ryu8, Yoo-Jung Park8, Seongsik Kang8, Young-Hoon Kim9. 1. Pharmaceutical Economics, Big Data Analysis & Policy, College of Pharmacy, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea. 2. Pharmaceutical Economics, Big Data Analysis & Policy, College of Pharmacy, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea. haesun.suh@khu.ac.kr. 3. Division of Cardiology, Department of Internal Medicine, Dankook University, Chung Nam, South Korea. 4. Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 5. Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 6. Division of Cardiology, Department of Internal Medicine, Catholic University of Korea, Seoul, South Korea. 7. Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea. 8. Pfizer Korea Ltd, Seoul, South Korea. 9. Division of Cardiology, Department of Internal Medicine, College of Medicine, Korea University Medical Center, Korea University, 73 Inchon-ro, Seongbuk-gu, Seoul, South Korea. yhkmd@korea.ac.kr.
Abstract
INTRODUCTION: Treatment persistence for anticoagulant therapy is important in preventing thromboembolism in nonvalvular atrial fibrillation (NVAF) patients. Understanding drug utilization pattern and treatment changes in oral anticoagulant (OAC) users may facilite better NVAF management. Thus, our study aimed to examine OAC treatment patterns preceding events leading to switch or discontinuation and medication adherence in Korean NVAF patients. METHODS: We conducted a drug utilization study on all Korean patients with atrial fibrillation (AF) newly prescribed OACs between July 2015 and November 2016 using the national claims data. We assessed treatment changes such as switching and discontinuation from index OAC and relevant events preceding the change and examined patient characteristics as predictors of changes that occurred among OAC users. Medication adherence was compared among OAC users by calculating the medication possession ratio (MPR). RESULTS: A total of 48,389 NVAF patients were identified who initiated OACs within the study period. Most initiated nonvitamin K antagonist oral anticoagulants (NOACs) (22% apixaban, 24% dabigatran, 37% rivaroxaban), and 18% initiated warfarin. The frequency of switch to another OAC was 8.8% for apixaban, 16.1% for dabigatran, 6.6% for rivaroxaban, and 19.1% for warfarin. The frequency of discontinuation was lower for apixaban (22.9%), dabigatran (26.3%), and rivaroxaban (25.7%) than warfarin (31.6%). Compared to warfarin, NOAC users were less likely to switch treatment. Thromboembolic event was the most common clinical event preceding switch from warfarin to NOAC and from NOAC to warfarin. Discontinuation of OAC was often preceded by a bleeding event. Patients who initiated apixaban showed significantly higher mean MPR compared to those on dabigatran and warfarin. CONCLUSION: In real-world practice in Korea, we have observed treatment change to be common in OAC users. Our results indicate better medication adherence with NOACs than with warfarin. (ClinicalTrials.gov registration number NCT03572972).
INTRODUCTION: Treatment persistence for anticoagulant therapy is important in preventing thromboembolism in nonvalvular atrial fibrillation (NVAF) patients. Understanding drug utilization pattern and treatment changes in oral anticoagulant (OAC) users may facilite better NVAF management. Thus, our study aimed to examine OAC treatment patterns preceding events leading to switch or discontinuation and medication adherence in Korean NVAF patients. METHODS: We conducted a drug utilization study on all Korean patients with atrial fibrillation (AF) newly prescribed OACs between July 2015 and November 2016 using the national claims data. We assessed treatment changes such as switching and discontinuation from index OAC and relevant events preceding the change and examined patient characteristics as predictors of changes that occurred among OAC users. Medication adherence was compared among OAC users by calculating the medication possession ratio (MPR). RESULTS: A total of 48,389 NVAF patients were identified who initiated OACs within the study period. Most initiated nonvitamin K antagonist oral anticoagulants (NOACs) (22% apixaban, 24% dabigatran, 37% rivaroxaban), and 18% initiated warfarin. The frequency of switch to another OAC was 8.8% for apixaban, 16.1% for dabigatran, 6.6% for rivaroxaban, and 19.1% for warfarin. The frequency of discontinuation was lower for apixaban (22.9%), dabigatran (26.3%), and rivaroxaban (25.7%) than warfarin (31.6%). Compared to warfarin, NOAC users were less likely to switch treatment. Thromboembolic event was the most common clinical event preceding switch from warfarin to NOAC and from NOAC to warfarin. Discontinuation of OAC was often preceded by a bleeding event. Patients who initiated apixaban showed significantly higher mean MPR compared to those on dabigatran and warfarin. CONCLUSION: In real-world practice in Korea, we have observed treatment change to be common in OAC users. Our results indicate better medication adherence with NOACs than with warfarin. (ClinicalTrials.gov registration number NCT03572972).
Authors: Manesh R Patel; Kenneth W Mahaffey; Jyotsna Garg; Guohua Pan; Daniel E Singer; Werner Hacke; Günter Breithardt; Jonathan L Halperin; Graeme J Hankey; Jonathan P Piccini; Richard C Becker; Christopher C Nessel; John F Paolini; Scott D Berkowitz; Keith A A Fox; Robert M Califf Journal: N Engl J Med Date: 2011-08-10 Impact factor: 91.245
Authors: Craig T January; L Samuel Wann; Hugh Calkins; Lin Y Chen; Joaquin E Cigarroa; Joseph C Cleveland; Patrick T Ellinor; Michael D Ezekowitz; Michael E Field; Karen L Furie; Paul A Heidenreich; Katherine T Murray; Julie B Shea; Cynthia M Tracy; Clyde W Yancy Journal: Circulation Date: 2019-01-28 Impact factor: 29.690
Authors: Christopher B Granger; John H Alexander; John J V McMurray; Renato D Lopes; Elaine M Hylek; Michael Hanna; Hussein R Al-Khalidi; Jack Ansell; Dan Atar; Alvaro Avezum; M Cecilia Bahit; Rafael Diaz; J Donald Easton; Justin A Ezekowitz; Greg Flaker; David Garcia; Margarida Geraldes; Bernard J Gersh; Sergey Golitsyn; Shinya Goto; Antonio G Hermosillo; Stefan H Hohnloser; John Horowitz; Puneet Mohan; Petr Jansky; Basil S Lewis; Jose Luis Lopez-Sendon; Prem Pais; Alexander Parkhomenko; Freek W A Verheugt; Jun Zhu; Lars Wallentin Journal: N Engl J Med Date: 2011-08-27 Impact factor: 91.245
Authors: Stuart J Connolly; Michael D Ezekowitz; Salim Yusuf; John Eikelboom; Jonas Oldgren; Amit Parekh; Janice Pogue; Paul A Reilly; Ellison Themeles; Jeanne Varrone; Susan Wang; Marco Alings; Denis Xavier; Jun Zhu; Rafael Diaz; Basil S Lewis; Harald Darius; Hans-Christoph Diener; Campbell D Joyner; Lars Wallentin Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Robert P Giugliano; Christian T Ruff; Eugene Braunwald; Sabina A Murphy; Stephen D Wiviott; Jonathan L Halperin; Albert L Waldo; Michael D Ezekowitz; Jeffrey I Weitz; Jindřich Špinar; Witold Ruzyllo; Mikhail Ruda; Yukihiro Koretsune; Joshua Betcher; Minggao Shi; Laura T Grip; Shirali P Patel; Indravadan Patel; James J Hanyok; Michele Mercuri; Elliott M Antman Journal: N Engl J Med Date: 2013-11-19 Impact factor: 91.245
Authors: Gerhard Hindricks; Tatjana Potpara; Nikolaos Dagres; Elena Arbelo; Jeroen J Bax; Carina Blomström-Lundqvist; Giuseppe Boriani; Manuel Castella; Gheorghe-Andrei Dan; Polychronis E Dilaveris; Laurent Fauchier; Gerasimos Filippatos; Jonathan M Kalman; Mark La Meir; Deirdre A Lane; Jean-Pierre Lebeau; Maddalena Lettino; Gregory Y H Lip; Fausto J Pinto; G Neil Thomas; Marco Valgimigli; Isabelle C Van Gelder; Bart P Van Putte; Caroline L Watkins Journal: Eur Heart J Date: 2021-02-01 Impact factor: 29.983
Authors: Jason G Andrade; Martin Aguilar; Clare Atzema; Alan Bell; John A Cairns; Christopher C Cheung; Jafna L Cox; Paul Dorian; David J Gladstone; Jeff S Healey; Paul Khairy; Kori Leblanc; M Sean McMurtry; L Brent Mitchell; Girish M Nair; Stanley Nattel; Ratika Parkash; Louise Pilote; Roopinder K Sandhu; Jean-François Sarrazin; Mukul Sharma; Allan C Skanes; Mario Talajic; Teresa S M Tsang; Atul Verma; Subodh Verma; Richard Whitlock; D George Wyse; Laurent Macle Journal: Can J Cardiol Date: 2020-10-22 Impact factor: 5.223