Adherence to Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation

To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries. Longitudinal drug utilization study of new users (≥18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation...

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Bibliographic Details
Authors: Sabaté, Mònica|||0000-0001-6206-1085, Vidal Guitart, Xavier|||0000-0001-6705-4298, Ballarín, Elena|||0000-0001-9786-6617, Rottenkolber, Mònica, Schmiedl, Sven, Grave, Birgit, Huerta, C., Martin Merino, Elisa, Montero, Dolores, Leon-Muñoz, L. M., Gasse, Christiane, Moore, Nicholas|||0000-0003-1212-2817, Droz, Cécile, Lassalle, Régis, Aakjær, Mia, Andersen, Morten|||0000-0001-7029-2860, De Bruin, Marie Louise, Souverein, Patrick|||0000-0002-7452-0477, Klungel, O. H., Gardarsdottir, Helga|||0000-0001-5623-9684, Ibáñez, Luisa|||0000-0002-1175-0574
Format: article
Publication Date:2021
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:292316
Online Access:https://ddd.uab.cat/record/292316
https://dx.doi.org/urn:doi:10.3389/fphar.2021.682890
Access Level:Open access
Keyword:Adherence
Anticoagulants
Cardiovascular
Drug utilization
Europe
Non valvular atrial fibrillation
Persistence
Pharmacoepidemiology
Description
Summary:To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries. Longitudinal drug utilization study of new users (≥18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation (2008-2015). Adherence was examined by estimating persistence, switching, and discontinuation rates at 12 months. Primary non-adherence was estimated in BIFAP and SIDIAP databases. The highest persistence rate was seen for apixaban in the CPRD database (81%) and the lowest for dabigatran in the Mondriaan database (22%). The switching rate for all DOACs ranged from 2.4 to 13.1% (Mondriaan and EGB databases, respectively). Dabigatran had the highest switching rate from 5.0 to 20.0% (Mondriaan and EGB databases, respectively). The discontinuation rate for all DOACs ranged from 16.0 to 63.9% (CPRD and Bavarian CD databases, respectively). Dabigatran had the highest rate of discontinuers, except in the Bavarian CD and AOK NORDWEST databases, ranging from 23.2 to 64.6% (CPRD and Mondriaan databases, respectively). Combined primary non-adherence for examined DOACs was 11.1% in BIFAP and 14.0% in SIDIAP. There were differences in population coverage and in the type of drug data source among the databases. Despite the differences in the characteristics of the databases and in demographic and baseline characteristics of the included population that could explain some of the observed discrepancies, we can observe a similar pattern throughout the databases. Apixaban was the DOAC with the highest persistence. Dabigatran had the highest proportion of discontinuers and switchers at 12 months in most databases (EMA/2015/27/PH).

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