Nelson Winnie W, Song Xue, Coleman Craig I, Thomson Erin, Smith David M, Damaraju C V, Schein Jeffrey R
Janssen Scientific Affairs, LLC , Raritan, NJ , USA.
Curr Med Res Opin. 2014 Dec;30(12):2461-9. doi: 10.1185/03007995.2014.933577. Epub 2014 Jun 25.
To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and warfarin in the US.
A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF treated with rivaroxaban or warfarin from 1 July 2010 through 31 March 2013. Index date was the date of the first prescription of rivaroxaban or warfarin. All patients were followed until the earliest of inpatient death, end of continuous enrollment, or end of study period. Rivaroxaban patients were matched 1:1 by propensity scores. Medication persistence was defined as absence of refill gap of ≥ 60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up. Cox proportional hazards models were estimated to examine the adjusted hazard ratios (aHRs) of rivaroxaban vs. warfarin on non-persistence and discontinuation.
A total of 32,886 NVAF patients on rivaroxaban or warfarin met the study inclusion criteria. Each of the 7259 rivaroxaban patients identified were matched 1:1 to warfarin patients. Patients on rivaroxaban had a significantly better rate of persistence (aHR: 0.63, 95% CI 0.59-0.68) and lower rate of discontinuation (aHR: 0.54, 95% CI 0.49-0.58) compared to warfarin recipients.
Claims data may have contained inaccuracies and miscoding. Confounding may remain even after propensity score matching and additional adjustments in model. Refill data may not fully reflect actual medication use. Longer follow-up may produce more precise estimates of persistence and discontinuation.
This matched cohort analysis indicated that rivaroxaban was associated with significantly higher medication persistence and lower discontinuation rates compared to warfarin.
比较美国非瓣膜性心房颤动（NVAF）患者使用利伐沙班和华法林的实际持续用药情况和停药情况。
利用一个具有全国代表性的大型美国索赔数据库，对2010年7月1日至2013年3月31日期间接受利伐沙班或华法林治疗的NVAF患者进行回顾性队列分析。索引日期为利伐沙班或华法林首次处方日期。所有患者均随访至住院死亡、连续参保结束或研究期结束三者中最早的时间点。利伐沙班患者按倾向得分进行1:1匹配。药物持续用药定义为无≥60天的再填充间隔。停药定义为至少90天无额外再填充且直至随访结束。估计Cox比例风险模型以检验利伐沙班与华法林在非持续用药和停药方面的调整后风险比（aHRs）。
共有32,886例使用利伐沙班或华法林的NVAF患者符合研究纳入标准。确定的7259例利伐沙班患者中的每一例均与华法林患者进行1:1匹配。与接受华法林治疗的患者相比，使用利伐沙班的患者持续用药率显著更高（aHR：0.63，95%CI 0.59 - 0.68），停药率更低（aHR：0.54，95%CI 0.49 - 0.58）。
索赔数据可能存在不准确和编码错误。即使在倾向得分匹配和模型中进行额外调整后，仍可能存在混杂因素。再填充数据可能无法完全反映实际用药情况。更长时间的随访可能会得出更精确的持续用药和停药估计值。
这项匹配队列分析表明，与华法林相比，利伐沙班与显著更高的药物持续用药率和更低的停药率相关。
