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Rivaroxaban linked to higher treatment adherence than warfarin among AF patients
Rivaroxaban was linked to significantly higher medication adherence and lower rates of discontinuation compared with warfarin among patients with nonvalvular atrial fibrillation in a recent retrospective cohort analysis.
Researchers searched the commercial and Medicare Truven Health MarketScan claims databases for patients with at least one medical claim related to a primary or secondary diagnosis of nonvalvular AF from 2009 to March 2013. All patients identified for analysis (n=32,886) also received at least one prescription for rivaroxaban (Xarelto, Janssen Pharmaceuticals) after November 2011 (n=7,259) or for warfarin after July 2010 (n=25,627), and had at least 6 months of continuous medical and prescription benefits before the study. Rivaroxaban recipients were matched at a 1:1 ratio with warfarin recipients via propensity score.
The follow-up interval was the time from the initial prescription to inpatient death or the end of the study period or of continuous enrollment with medical and prescription benefits (mean 184 days for rivaroxaban and 408 days for warfarin). Evaluated endpoints included medication persistence and discontinuation. Nonpersistence was defined as a refill gap of at least 60 days after the end of a medication supply, and discontinuation was defined as at least 90 days without an additional prescription refill.
During follow-up, patients in the rivaroxaban group had a 77.1% rate of medication persistency vs. 57.8% in the warfarin group. Rivaroxaban recipients were less likely to be nonpersistent than warfarin recipients (adjusted HR=0.63; 95% CI, 0.59-0.68). Older age, higher CHADS2 scores, chronic kidney disease and treatment with multiple medications were linked to significantly decreased risk for nonpersistence. Conversely, living in the South and West regions of the United States (vs. the Northeast), a higher ATRIA score, the presence of psychiatric disease and higher out-of-pocket costs were linked to significantly increased risk for nonpersistence.
In an analysis of 5,659 rivaroxaban recipients and 5,957 warfarin recipients with evaluable discontinuation data, patients in the rivaroxaban group discontinued medication less frequently than warfarin recipients (20.9% of cases vs. 41.5%). Adjustment for patient characteristics revealed that treatment with rivaroxaban was linked to a 46% lower risk of discontinuation vs. warfarin (adjusted HR=0.54; 95% CI: 0.49-0.58). The risk for discontinuation was further decreased in a subset of patients who did not switch anticoagulants during the study period (adjusted HR=0.44; 95% CI, 0.4-0.48). Patient factors linked to significantly lower risk for discontinuation included older age, chronic kidney disease and receipt of more medications.
“Medication nonadherence has been shown to have a damaging effect on patient outcomes and the health care system as a whole,” researcher Winnie W. Nelson, PharmD, director of health economics and outcomes research at Janssen Pharmaceuticals, said in a press release. “These new findings and other data suggest Xarelto … may be conducive to greater patient adherence.”
Disclosure: See the full study for a list of researchers’ financial disclosures.