Impact of apixaban treatment discontinuation on the risk of hospitalization among patients with nonvalvular atrial fibrillation and COVID-19

Abstract

Introduction

This study evaluated the risk of hospitalization among nonvalvular atrial fibrillation (NVAF) patients with an outpatient COVID-19 diagnosis who discontinued vs continued apixaban treatment.

Methods

Adult patients with NVAF with an apixaban prescription prior to an outpatient COVID-19 diagnosis were identified from Optum Clinformatics claims database (1 April 2020–31 March 2021). Continuers were those who continued apixaban as of the index date (date of initial outpatient COVID-19 diagnosis) and discontinuers were those who had the last day of apixaban supply on or before index. Patients were followed from COVID-19 diagnosis to change of continuation/discontinuation status, switch, death, end of continuous coverage or study end, whichever occurred first. Inverse probability treatment weighting (IPTW) was performed to balance cohorts. Cox proportional hazard models were used to compare the risk of all-cause hospitalization and hospitalization for ischemic stroke (IS), venous thromboembolism (VTE), myocardial infarction (MI), bleeding and mortality.

Results

A total of 7869 apixaban patients with COVID-19 were included: 6676 continuers (84.8%) and 1193 discontinuers (15.2%). Compared with continuers, discontinuers had a higher risk of all-cause hospitalization (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.08–1.40), IS (HR: 2.00; 95% CI: 1.03–3.87), VTE (HR: 2.37; 95% CI: 1.06–5.27) and mortality (HR: 2.28; 95% CI: 1.85–2.80). There were no significant differences in the risk of MI (HR: 1.01; 95% CI: 0.54–1.90) or bleeding-related hospitalization (HR: 1.13; 95% CI: 0.73–1.76).

Conclusion

NVAF patients with COVID-19 who discontinued apixaban had a higher risk of hospitalization and thrombotic events vs those who continued apixaban, with no significant difference in bleeding-related hospitalization.

Keywords:

• COVID-19
• atrial fibrillation
• apixaban
• adherence

Transparency

Declaration of funding

This study was sponsored by Bristol Myers Squibb and Pfizer.

Declaration of financial/other relationships

J.Z., J.J., M.F., L.R., P.S. and A.D.D. have disclosed that they are paid employees and shareholders of Bristol Myers Squibb. X.L. has disclosed that she is a paid employee and shareholder of Pfizer. A.K. and C.G. have disclosed that they were paid employees of STATinMED, LLC at the time of this study, who were paid consultants to Pfizer and Bristol Myers Squibb in connection with the development of this manuscript. S.D. has disclosed that he is a paid consultant in connection with the development of this manuscript and a consultant for Bayer/Janssen, Bristol Myers Squibb /Pfizer, Daiichi-Sankyo, Portola and Boehringer Ingelheim; and has been on the speakers’ bureaus for Janssen, Bristol Myers Squibb/Pfizer and Boehringer Ingelheim.

Author contributions

S.D., A.D.D., X.L., L.R., M.F. and P.S. – conception and design, interpretation of data, critical review of manuscript, final approval. J.J. and J.Z. – conception and design, analysis and interpretation of data, critical review of manuscript, final approval. A.K. and C.G. – conception and design, interpretation of data, drafting/revising and critical review of manuscript, final approval. All authors agree to be accountable for all aspects of the work.

Acknowledgements

Editorial support for this study was provided by Christopher Moriarty of STATinMED, LLC. Funding for editorial support was provided by Pfizer and Bristol Myers Squibb.

Data availability statement

Data for these analyses were made available to the authors through third-party licenses from Optum commercial data providers in the US and BMS (who has licenses for analysis of these data). As such, the authors cannot provide the raw data themselves. Other researchers could access these data by purchasing a third party license through this commercial data provider. Inclusion criteria specified in the methods section would allow other researchers to identify the same cohort of patients we used for these analyses. Interested individuals may see https://www.optum.com/solutions/prod-nav/product-data.html for more information on accessing Optum data. We confirm that no authors had special privileges to access data from Optum via third-party licenses, and that other researchers would be able to access these data in the same manner as the authors.