Anticoagulant Treatment Adherence and Persistence in German Patients with Atrial Fibrillation

Giuseppe Patti; Rosa Wang; Xiaocong Li Marston; Yu-Chen Yeh; Lisa Zimmermann; Xin Ye; Xin Gao; Bernd Brüggenjürgen

doi:10.1007/s40119-023-00315-8

Anticoagulant Treatment Adherence and Persistence in German Patients with Atrial Fibrillation

Cardiol Ther. 2023 Jun;12(2):371-391. doi: 10.1007/s40119-023-00315-8. Epub 2023 May 3.

Authors

Giuseppe Patti¹, Rosa Wang², Xiaocong Li Marston³, Yu-Chen Yeh⁴, Lisa Zimmermann⁵, Xin Ye², Xin Gao⁴, Bernd Brüggenjürgen⁶

Affiliations

¹ University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy. giuseppe.patti@uniupo.it.
² Daiichi Sankyo Inc., Basking Ridge, NJ, USA.
³ OPEN Health, Shanghai, China.
⁴ OPEN Health, Bethesda, MD, USA.
⁵ Gesundheitsforen, Leipzig, Germany.
⁶ Orthopedic Department, Medical School Hannover at DIAKOVERE Annastift Hospital, Hannover, Germany.

Abstract

Introduction: Treatment adherence and persistence impact the effectiveness of edoxaban for the prevention of thromboembolism in patients with atrial fibrillation (AF). The objective of this analysis was to assess adherence and persistence of edoxaban vs. other non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs).

Methods: Utilizing a German claims database, adults with AF with the first pharmacy claim identified for edoxaban, apixaban, dabigatran, rivaroxaban, or VKAs from January 2013 to December 2017 were included in a propensity score-matched analysis. The first pharmacy claim was the index claim. Adherence (i.e., proportion of days covered [PDC]) and persistence (proportion of patients who continued therapy) were compared between edoxaban and other therapies. Patients receiving once-daily (QD) vs. twice-daily (BID) NOAC were also analyzed.

Results: Overall, 21,038 patients were included (1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA). After matching, baseline characteristics were well balanced across cohorts. Adherence was significantly higher for edoxaban vs. apixaban, dabigatran, and VKAs (all P < 0.0001). Significantly more edoxaban patients continued therapy vs. rivaroxaban (P = 0.0153), dabigatran (P < 0.0001), and VKAs (P < 0.0001). Time to discontinuation was significantly longer for edoxaban vs. dabigatran, rivaroxaban, and VKAs (all P < 0.0001). More patients receiving NOACs QD had a PDC ≥ 0.8 compared with those receiving NOACs BID (65.3 vs. 49.6%, respectively; P < 0.05); persistence rates were comparable between QD and BID groups.

Conclusions: Patients with AF receiving edoxaban had significantly higher adherence and persistence compared with those receiving VKAs. This trend was also seen in NOAC QD regimens vs. NOAC BID regimens for adherence. These results provide insight into how adherence and persistence may contribute to the effectiveness of edoxaban for stroke prevention in patients with AF in Germany.

Keywords: Anticoagulants; Arrythmias and device therapy; Atrial fibrillation (AF); Edoxaban; Interventional cardiology.