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Real‐World Adherence and Persistence with Direct Oral Anticoagulants in Adults with Atrial Fibrillation
Author(s) -
Manzoor Beenish S.,
Lee Todd A.,
Sharp Lisa K.,
Walton Surrey M.,
Galanter William L.,
Nutescu Edith A.
Publication year - 2017
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1989
Subject(s) - medicine , atrial fibrillation , dabigatran , persistence (discontinuity) , medical prescription , medication adherence , apixaban , rivaroxaban , warfarin , pharmacology , geotechnical engineering , engineering
Background Evidence of adherence and persistence patterns in anticoagulation ( AC ) therapy comparing treatment‐naïve and non‐naïve patients is lacking. The objective of this study was to evaluate patterns of medication adherence and persistence in a real‐world setting among AC ‐naïve and AC ‐experienced patients with atrial fibrillation ( AF ) who were treated with direct oral anticoagulants ( DOAC s). Methods AF patients newly initiating a DOAC with a minimum of 6 months of continuous health plan enrollment pre and postindex date (first DOAC prescription) were identified from the Truven Health MarketScan Commercial and Medicare Supplemental databases (2009–2013). DOAC adherence (proportion of days covered [ PDC ]), persistence, and predictors of adherence were assessed at 6 and 12 months postindex. Results Of 66,090 AF patients included, 46.6% (n=30,826) were AC naïve and 53.4% (n=35,264) were AC experienced (age: 66.9 ± 12.7 vs 70.4 ± 11.4 yrs, p<0.001; male: n=19,132 [62.1%] vs n=21,691 [61.5%], p=0.14, respectively). A majority of patients received dabigatran as their index DOAC (n=49,210; 74.5%). The mean PDC in AC ‐naïve versus AC ‐experienced patients at 6 and 12 months of follow‐up was 72.3% versus 83.3% (p<0.001) and 63.7% versus 79.9% (p<0.001), respectively. Persistence with DOAC therapy in AC ‐naïve and AC ‐experienced patients at 6 and 12 months ranged from 59.3% and 76.3% (p<0.0001) to 31.6% and 50.2% (p<0.0001), respectively. Predictors of higher DOAC adherence were older age and higher number of concomitant medications. Predictors of lower adherence were higher number of comorbidities and AC ‐naïve user status. Conclusion Medication adherence and persistence with DOAC s declined over time and both were suboptimal and lower (at 6 and 12 mo postindex) in AC ‐naïve compared to AC ‐experienced patients. These findings can help target future strategies or interventions for patient education and long‐term AC management especially in those patients naïve to DOAC therapy. Future investigation should examine potential reasons for differences in DOAC adherence and persistence between AC ‐experienced versus AC ‐naïve patients and the implications for patient outcomes.