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Medication adherence to rivaroxaban and dabigatran in patients with non-valvular atrial fibrillation: a meta-analysis

  • Ashley Prentice
  • Irene Ruiz
  • Erin R. WeedaEmail author
Article

Abstract

Several real-world studies have evaluated adherence to direct acting oral anticoagulants in patients with non-valvular atrial fibrillation (NVAF); however, these studies have not been systematically summarized. We performed a meta-analysis to compare adherence to rivaroxaban versus dabigatran therapy in United States (US) patients with NVAF in a real-world setting. Medline and Scopus were searched from January 2010 to August 2018 using keywords and MeSH terms related to adherence and oral anticoagulants. We included real-world studies of US adults with NVAF comparing adherence to dabigatran and rivaroxaban. Studies evaluating adherence by a measure other than proportion of days covered (PDC) were excluded. The proportion of patients with a PDC ≥ 80 (a commonly utilized definition of adherence) served as the primary outcome of interest. We conducted meta-analysis of non-overlapping studies using the Hartung–Knapp random-effects model to estimate risk ratios (RRs) with corresponding 95% confidence intervals (CIs). We included 5 studies evaluating 80,230 patients (range 2667–22,571). Median follow-up across studies was 6 months (range 3–12 months). The proportion of patients with a PDC ≥ 80 ranged from 59.5 to 83.5% for rivaroxaban users and 57.3 to 78.3% for dabigatran users. Upon meta-analysis, rivaroxaban use was associated with increased adherence compared with dabigatran use (RR  1.08; 95% CI  1.03–1.12; I2 = 88%). In conclusion, rivaroxaban was associated with increased adherence when compared to dabigatran in ~ 80,000 patients in a real-world setting. Possible explanations for this include dosing frequency or patient tolerance.

Keywords

Medication adherence Direct oral anticoagulant Atrial fibrillation Proportion of days covered 

Notes

Funding

None.

Compliance with ethical standards

Conflicts of interest

Dr. Weeda has received research funding from Pfizer Inc. No other authors report conflicts of interest.

Supplementary material

11239_2019_1986_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 kb)

References

  1. 1.
    Reading SR, Black MH, Singer DE et al (2019) Risk factors for medication non-adherence among atrial fibrillation patients. BMC Cardiovasc Disord 19(1):38CrossRefGoogle Scholar
  2. 2.
    Granger CB, Alexander JH, McMurray JJ et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365(11):981–992CrossRefGoogle Scholar
  3. 3.
    Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151CrossRefGoogle Scholar
  4. 4.
    Borne RT, O’Donnell C, Turakhia MP et al (2017) Adherence and outcomes to direct oral anticoagulants among patients with atrial fibrillation: findings from the veterans health administration. BMC Cardiovasc Disord 17(1):236–236CrossRefGoogle Scholar
  5. 5.
    Yao X, Abraham NS, Alexander GC et al (2016) Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. J Am Heart Assoc 5(2):e003074CrossRefGoogle Scholar
  6. 6.
    McHorney CA, Crivera C, Laliberte F et al (2015) Adherence to non-vitamin-K-antagonist oral anticoagulant medications based on the Pharmacy Quality Alliance measure. Curr Med Res Opin 31(12):2167–2173CrossRefGoogle Scholar
  7. 7.
    McHorney CA, Ashton V, Laliberte F et al (2017) Adherence to rivaroxaban compared with other oral anticoagulant agents among patients with nonvalvular atrial fibrillation. J Manag Care Spec Pharm 23(9):980–988PubMedGoogle Scholar
  8. 8.
    Coleman CI, Tangirala M, Evers T (2016) Medication adherence to rivaroxaban and dabigatran for stroke prevention in patients with non-valvular atrial fibrillation in the United States. Int J Cardiol 212:171–173CrossRefGoogle Scholar
  9. 9.
    Dreyer NA, Bryant A, Velentgas P (2016) The GRACE checklist: a validated assessment tool for high quality observational studies of comparative effectiveness. J Manag Care Spec Pharm 22(10):1107–1113PubMedGoogle Scholar
  10. 10.
    Pharmacy Quality Alliance. PQA measure overview. Available at: https://www.pqaalliance.org/assets/Measures/PQA%20Measure%20Overview%20082018.pdf Last Accessed July 2, 2019
  11. 11.
    Luger S, Hohmann C, Niemann D et al (2015) Adherence to oral anticoagulant therapy in secondary stroke prevention—impact of the novel oral anticoagulants. Patient Prefer Adher 9:1695–1705Google Scholar
  12. 12.
    Rossi AP, Facchinetti R, Ferrari E et al (2018) Predictors of self-reported adherence to direct oral anticoagulation in a population of elderly men and women with non-valvular atrial fibrillation. J Thromb Thrombolysis 46(2):139–144CrossRefGoogle Scholar
  13. 13.
    Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497CrossRefGoogle Scholar
  14. 14.
    Shore S, Carey EP, Turakhia MP et al (2014) Adherence to dabigatran therapy and longitudinal patient outcomes: insights from the veterans health administration. Am Heart J 167(6):810–817CrossRefGoogle Scholar
  15. 15.
    Weeda ER, Coleman CI, McHorney CA, Crivera C, Schein JR, Sobieraj DM (2016) Impact of once- or twice-daily dosing frequency on adherence to chronic cardiovascular disease medications: a meta-regression analysis. Int J Cardiol 216:104–109CrossRefGoogle Scholar
  16. 16.
    Bytzer P, Connolly SJ, Yang S et al (2013) Analysis of upper gastrointestinal adverse events among patients given dabigatran in the RE-LY trial. Clin Gastroenterol Hepatol 11(3):246–252 e241–245 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of PharmacyMedical University of South CarolinaCharlestonUSA

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