Department of Pharmacy, Systems Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood St, PHARM 227 (MC 871), Chicago, IL, 60612, USA.
Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
J Thromb Thrombolysis. 2017 Nov;44(4):435-441. doi: 10.1007/s11239-017-1565-2.
Real-world evidence focusing on medication switching patterns amongst direct oral anticoagulant (DOACs) has not been well studied. The objective of this study is to evaluate patterns of prescription switching in non-valvular atrial fibrillation (NVAF) patients initiated on a DOAC and previously naïve to anticoagulation (AC) therapy. Data was obtained from Truven Health MarketScan Commercial and Medicare Supplemental database (2009-2013). AC naïve (those without prior anticoagulant use) NVAF patients initiated on a DOAC, with 6 months of continuous health plan enrollment before and after treatment initiation and maintained on continuous therapy for a minimum of 6 months were included. Of 34,022 AC naïve NVAF patients initiating a DOAC, 6613 (19.4%) patients switched from an index DOAC prescription to an alternate anticoagulant and 27,409 (80.6%) remained on the DOAC [age: 68.5 ± 11.7 vs. 67.1 ± 12.7 years, p < 0.001; males: 3781 (57.2%) vs. 17,160 (62.6%), p < 0.001]. Amongst those that switched medication, 3196 (48.3%) did so within the first 6 months of therapy. Overall, 2945 (44.5%) patients switched to warfarin, 2912 (44.0%) switched to another DOAC and 756 (11.4%) switched to an injectable anticoagulant. The highest proportion of patients switched from dabigatran to warfarin (N = 2320; 42.5%) or rivaroxaban (N = 2252; 41.3%). The median time to switch from the index DOAC to another DOAC was 309.5 days versus 118.0 days (p < 0.001) to switch to warfarin. In NVAF patients newly initiated on DOAC therapy, one in five patients switch to an alternate anticoagulant and one of every two patients do so within the first 6 months of therapy. Switching from an initial DOAC prescription to traditional anticoagulants occurs as frequently as switching to an alternate DOAC.
真实世界证据聚焦于直接口服抗凝剂（DOAC）的药物转换模式，但目前对此研究甚少。本研究旨在评估新型口服抗凝剂（NOAC）治疗初治非瓣膜性心房颤动（NVAF）患者的处方转换模式，这些患者之前未接受过抗凝治疗。数据来自 Truven Health MarketScan 商业和补充医疗保险数据库（2009-2013 年）。纳入的患者为：在开始治疗前和治疗开始后 6 个月内连续参加健康计划，且至少连续接受 6 个月治疗的初始 NOAC 治疗、无抗凝治疗史（既往未使用过任何抗凝药物）的 NVAF 患者。在 34022 例初始使用 DOAC 的 NVAF 患者中，有 6613 例（19.4%）患者从初始 DOAC 处方转换为其他抗凝药物，27409 例（80.6%）患者继续使用 DOAC[年龄：68.5±11.7 岁比 67.1±12.7 岁，p<0.001；男性：3781 例（57.2%）比 17160 例（62.6%），p<0.001]。在药物转换的患者中，有 3196 例（48.3%）在治疗的前 6 个月内进行了转换。总体而言，2945 例（44.5%）患者转换为华法林，2912 例（44.0%）转换为另一种 DOAC，756 例（11.4%）转换为注射用抗凝剂。从达比加群转换为华法林（N=2320；42.5%）或利伐沙班（N=2252；41.3%）的患者比例最高。从初始 DOAC 转换为另一种 DOAC 的中位时间为 309.5 天，而转换为华法林的中位时间为 118.0 天（p<0.001）。在新开始 DOAC 治疗的 NVAF 患者中，每五名患者中就有一名患者会转换为另一种抗凝药物，而每两名患者中就有一名患者会在治疗的前 6 个月内进行转换。从初始 DOAC 处方转换为传统抗凝药物与转换为另一种 DOAC 的频率一样高。
