Medication persistence and discontinuation of rivaroxaban versus warfarin among patients with non-valvular atrial fibrillation

Abstract

Objectives:

To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and warfarin in the US.

Research design and methods:

A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF treated with rivaroxaban or warfarin from 1 July 2010 through 31 March 2013. Index date was the date of the first prescription of rivaroxaban or warfarin. All patients were followed until the earliest of inpatient death, end of continuous enrollment, or end of study period. Rivaroxaban patients were matched 1:1 by propensity scores. Medication persistence was defined as absence of refill gap of ≥60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up. Cox proportional hazards models were estimated to examine the adjusted hazard ratios (aHRs) of rivaroxaban vs. warfarin on non-persistence and discontinuation.

Results:

A total of 32,886 NVAF patients on rivaroxaban or warfarin met the study inclusion criteria. Each of the 7259 rivaroxaban patients identified were matched 1:1 to warfarin patients. Patients on rivaroxaban had a significantly better rate of persistence (aHR: 0.63, 95% CI 0.59–0.68) and lower rate of discontinuation (aHR: 0.54, 95% CI 0.49–0.58) compared to warfarin recipients.

Limitations:

Claims data may have contained inaccuracies and miscoding. Confounding may remain even after propensity score matching and additional adjustments in model. Refill data may not fully reflect actual medication use. Longer follow-up may produce more precise estimates of persistence and discontinuation.

Conclusion:

This matched cohort analysis indicated that rivaroxaban was associated with significantly higher medication persistence and lower discontinuation rates compared to warfarin.

Keywords::

• Non-valvular atrial fibrillation
• Persistence
• Rivaroxaban
• Warfarin

Transparency

Declaration of funding

The current study was sponsored by Janssen Scientific Affairs LLC.

Declaration of financial/other relationships

W.W.N., C.V.D., and J.R.S. have disclosed that they are employees of Janssen Scientific Affairs LLC. C.I.C. has disclosed that he has received research funding from Janssen Scientific Affairs LLC and serves on their speaker’s bureau for Xarelto. X.S., E.T., and D.M.S. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgments

The authors express gratitude to Monika Raut of Janssen Scientific Affairs LLC for editorial review of the author-prepared manuscript.