Pham Phuong N, Brown Joshua D
Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, 1225 Center Drive, HPNP #3320, Gainesville, FL, 32610, USA.
BMC Cardiovasc Disord. 2019 Mar 19;19(1):64. doi: 10.1186/s12872-019-1033-3.
Differences in adherence may represent drug properties (e.g. dosing interval) or patient experiences while on treatment. Adherence to direct oral anticoagulants (DOACs) in nonvalvular atrial fibrillation (NVAF) is important to maintain effectiveness over the course of treatment.
This was a retrospective cohort study using 2009-2015 Truven Health MarketScan Databases. New initiators of dabigatran, rivaroxaban, and apixaban with NVAF were identified. Twelve months of continuous enrollment before treatment was required to assess demographics and medical history. Proportion of days cover (PDC) was used to measure adherence at 3, 6, 9 and 12-month. Gaps in therapy and treatment switches were also evaluated. Logistic regression was used to compare high adherence (PDC ≥0.80).
A total of 14,864 dabigatran, 16,005 rivaroxaban, and 8078 apixaban users were identified. Apixaban users had the highest adherence overall, with mean PDC at 3, 6, 9, and 12-months of 0.83, 0.76, 0.72, and 0.69, while dabigatran had the lowest adherence of 0.78, 0.67, 0.61, and 0.57. Adherence to DOACs increased with increased stroke risk scores. Adherence was also higher when first days supplied was > 30 days compared to 30 days and when filled via mail order pharmacies. Switching was highest among dabigatran users. Apixaban users were the most likely to have high adherence versus dabigatran (OR = 1.73, 95% CI = 1.60-1.88) and versus rivaroxaban (OR = 1.24, 95% CI = 1.14-1.34) at 12-months.
Apixaban users had the highest overall adherence despite twice-daily dosing versus once-daily dosing for rivaroxaban. These findings can be useful for formulary decision-making and when assessing treatment options.
服药依从性的差异可能代表药物特性（如给药间隔）或患者治疗期间的体验。在非瓣膜性心房颤动（NVAF）中，坚持使用直接口服抗凝剂（DOAC）对于维持整个治疗过程的有效性很重要。
这是一项使用2009 - 2015年Truven Health MarketScan数据库的回顾性队列研究。确定了使用达比加群、利伐沙班和阿哌沙班治疗NVAF的新使用者。在治疗前需要连续登记12个月以评估人口统计学和病史。使用日覆盖比例（PDC）来衡量3、6、9和12个月时的依从性。还评估了治疗中断和治疗转换情况。使用逻辑回归比较高依从性（PDC≥0.80）情况。
共确定了14864名达比加群使用者、16005名利伐沙班使用者和8078名阿哌沙班使用者。阿哌沙班使用者总体依从性最高，3、6、9和12个月时的平均PDC分别为0.83、0.76、0.72和0.69，而达比加群的依从性最低，分别为0.78、0.67、0.61和0.57。对DOACs的依从性随着中风风险评分的增加而提高。与供应首日为30天相比，供应首日>30天时依从性也更高，并且通过邮购药房配药时依从性更高。达比加群使用者的治疗转换率最高。在12个月时，与达比加群相比，阿哌沙班使用者最有可能具有高依从性（OR = 1.73，95%CI = 1.60 - 1.88），与利伐沙班相比也是如此（OR = 1.24，
