Medication persistence and discontinuation of rivaroxaban and dabigatran etexilate among patients with non-valvular atrial fibrillation

Abstract

Objective:

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

Methods:

A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF on rivaroxaban or dabigatran between October 2010 and March 2013. The index date was the date of the first prescription of rivaroxaban or dabigatran. All patients had ≥6 months of data prior to the index date and were followed until the earliest of inpatient death, end of continuous enrollment, or end of the study period. Rivaroxaban patients were matched 1:1 with dabigatran patients using the propensity score matching technique. Cox proportional hazards models were employed to estimate the adjusted hazard ratios (aHRs) of non-persistence and discontinuation. Persistence was defined as absence of a refill gap of ≥60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up.

Results:

A total of 30,337 NVAF patients on rivaroxaban or dabigatran met the study criteria. All 7259 rivaroxaban patients were matched 1:1 to dabigatran patients. Compared with dabigatran users, rivaroxaban patients were 11% less likely to become non-persistent with therapy (aHR: 0.89, 95% CI 0.84–0.95) and 29% less likely to discontinue therapy (aHR: 0.71, 95% CI 0.66–0.77).

Limitations:

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

Conclusions:

This matched cohort analysis indicated that, compared to dabigatran, rivaroxaban was associated with better persistence and lower rates of discontinuation.

Keywords: :

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

Transparency

Declaration of funding

This research was sponsored by Janssen Scientific Affairs LLC and was conducted primarily by Truven Health Analytics. Truven Health Analytics provides custom consulting services to all major pharmaceutical and biotech companies. As part of a consulting agreement with Truven Health Analytics, Janssen Scientific Affairs LLC provided funding to Truven Health Analytics to support protocol development, data analysis, and manuscript development activities associated with this study.

Declaration of financial/other relationships

W.W.N. has disclosed that she is a shareholder of Johnson & Johnson, parent company of Janssen Scientific Affairs, and an employee of Janssen Scientific Affairs, the study sponsor. X.S., E.T., and D.M.S. have disclosed that they are employees of Truven Health Analytics, a paid consultant to Janssen Pharmaceuticals Inc. C.I.C. has disclosed that he is a recipient of grant/research funding from Janssen Pharmaceuticals and Boehringer-Ingelheim and is a member of the Janssen Pharmaceuticals Speakers Bureau for Xarelto. C.V.D. has disclosed that he is a shareholder and an employee of Johnson & Johnson, parent company of Janssen Scientific Affairs. J.R.S. has disclosed that he is a shareholder and an employee of Janssen Scientific Affairs.

CMRO peer reviewer 1 has disclosed that he has received grants from Bayer, Boehringer Ingelheim, Pfizer and Bristol-Meyers Squibb, and is a consultant to and is on the Speakers’ Bureaus of these four companies. Peer reviewers 2 and 3 have no relevant financial relationships to disclose.

Acknowledgments

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