Adherence to Direct Oral Anticoagulants in Patients With Non-Valvular Atrial Fibrillation: A Cross-National Comparison in Six European Countries (2008-2015)

被引:10
作者
Sabate, M. [1 ,2 ,3 ]
Vidal, X. [1 ,2 ,3 ]
Ballarin, E. [1 ,2 ]
Rottenkolber, M. [4 ]
Schmiedl, S. [5 ,6 ]
Grave, B. [7 ]
Huerta, C. [8 ]
Martin-Merino, E. [8 ]
Montero, D. [8 ]
Leon-Munoz, L. M. [8 ]
Gasse, C. [9 ]
Moore, N. [10 ]
Droz, C. [10 ]
Lassalle, R. [10 ]
Aakjaer, M. [11 ]
Andersen, M. [11 ]
De Bruin, M. L. [12 ]
Souverein, P. [13 ]
Klungel, O. H. [13 ,14 ]
Gardarsdottir, H. [13 ,15 ,16 ]
Ibanez, L. [1 ,2 ,3 ]
机构
[1] Fundacio Inst Catal Farmacol FICF, Barcelona, Spain
[2] Hosp Univ Vall dHebron, Dept Clin Pharmacol, Barcelona, Spain
[3] Univ Autonoma Barcelona, Dept Pharmacol Toxicol & Therapeut, Barcelona, Spain
[4] Klinikum Univ Munchen, Med Klin & Poliklin 4, Diabet Res Grp, Munich, Germany
[5] Witten Herdecke Univ, Fac Hlth, Sch Med, Dept Clin Pharmacol, Witten, Germany
[6] Helios Univ, Philipp Klee Inst Clin Pharmacol, Hosp Wuppertal, Wuppertal, Germany
[7] AOK NORDWEST, Dortmund, Germany
[8] Spanish Agcy Med & Med Devices AEMPS, Pharmacoepidemiol & Pharmacovigilance Div, Madrid, Spain
[9] Aarhus Univ, Aarhus, Denmark
[10] Univ Bordeaux, CHU Bordeaux, INSERM CIC1401, Bordeaux PharmacoEpi, Bordeaux, France
[11] Univ Copenhagen, Fac Hlth & Med Sci, Pharmacovigilance Res Ctr, Dept Drug Design & Pharmacol, Copenhagen, Denmark
[12] Univ Copenhagen, Fac Hlth & Med Sci, Copenhagen Ctr Regulatory Sci CORS, Dept Pharm, Copenhagen, Denmark
[13] Univ Utrecht, Fac Sci, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands
[14] Univ Med Ctr Utrecht, Julius Ctr, Utrecht, Netherlands
[15] Univ Med Ctr Utrecht, Dept Clin Pharm, Utrecht, Netherlands
[16] Univ Iceland, Fac Pharmaceut Sci, Reykjavik, Iceland
关键词
adherence; persistence; anticoagulants; non valvular atrial fibrillation; cardiovascular; drug utilization; pharmacoepidemiology; europe; VITAMIN-K ANTAGONISTS; REAL-WORLD; TREATMENT PERSISTENCE; PRIMARY NONADHERENCE; STROKE PREVENTION; RIVAROXABAN; WARFARIN; DABIGATRAN; APIXABAN; SYSTEM;
D O I
10.3389/fphar.2021.682890
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Aims: To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries.Methods: Longitudinal drug utilization study of new users (>= 18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation (2008-2015). Adherence was examined by estimating persistence, switching, and discontinuation rates at 12 months. Primary non-adherence was estimated in BIFAP and SIDIAP databases.Results: The highest persistence rate was seen for apixaban in the CPRD database (81%) and the lowest for dabigatran in the Mondriaan database (22%). The switching rate for all DOACs ranged from 2.4 to 13.1% (Mondriaan and EGB databases, respectively). Dabigatran had the highest switching rate from 5.0 to 20.0% (Mondriaan and EGB databases, respectively). The discontinuation rate for all DOACs ranged from 16.0 to 63.9% (CPRD and Bavarian CD databases, respectively). Dabigatran had the highest rate of discontinuers, except in the Bavarian CD and AOK NORDWEST databases, ranging from 23.2 to 64.6% (CPRD and Mondriaan databases, respectively). Combined primary non-adherence for examined DOACs was 11.1% in BIFAP and 14.0% in SIDIAP. There were differences in population coverage and in the type of drug data source among the databases.Conclusion: Despite the differences in the characteristics of the databases and in demographic and baseline characteristics of the included population that could explain some of the observed discrepancies, we can observe a similar pattern throughout the databases. Apixaban was the DOAC with the highest persistence. Dabigatran had the highest proportion of discontinuers and switchers at 12 months in most databases (EMA/2015/27/PH).
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页数:14
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