Cano Stefan, Mantovani Lorenzo, Folkerts Kerstin, Gebel Martin, Sahin Kurtulus, Zell Elizabeth, Monje Danja, Schneider Jonas, Eickels Martin van, Haas Sylvia, Kreutz Reinhold, Ageno Walter, Turpie Alexander G G
Modus Outcomes, Letchworth Garden City, United Kingdom.
CESP-Center for Public Health Research, University of Milan Bicocca, Monza, Italy.
TH Open. 2018 Apr 11;2(2):e139-e146. doi: 10.1055/s-0038-1641679. eCollection 2018 Apr.
For venous thromboembolism (VTE) treatment, patient satisfaction was shown to improve with rivaroxaban versus standard anticoagulation in the phase III EINSTEIN DVT and EINSTEIN PE trials. This substudy of the prospective, noninterventional XALIA study of rivaroxaban for deep-vein thrombosis treatment assessed if this was also observed in routine clinical practice. Patients enrolled in XALIA who received rivaroxaban or standard anticoagulation treatment were eligible for inclusion in this substudy. Treatment decisions were at the physician's discretion. Patients completed the 17-item Anti-Clot Treatment Scale (ACTS, comprising a 12-item Burdens subscale, a 3-item Benefits subscale and one global item per subscale) during follow-up. The propensity score-matched set (PMS) was used for the main analysis; the adjusted safety analysis (ASAF) set was used for confirmatory purposes. Analyses by follow-up visit and subgroup, including age, sex, and previous VTE, were also conducted. The PMS-ACTS analysis included 458 rivaroxaban-treated and 434 standard anticoagulation-treated patients. Baseline demographic and clinical characteristics were generally similar across treatment arms. ACTS Burdens scores significantly improved with rivaroxaban versus standard anticoagulation (least-squares mean difference of 2.4 ± 0.4 points; < 0.0001); ACTS Benefits scores were numerically higher with rivaroxaban (least-squares mean difference of 0.2 ± 0.1 points; = 0.2). Similar findings occurred across follow-up visits and subgroups. Results were confirmed in the ASAF-ACTS analysis. Consistent with phase III analyses, rivaroxaban was associated with improved ACTS Burdens scores; ACTS Benefits scores numerically favored rivaroxaban, although without reaching statistical significance.
在III期EINSTEIN DVT和EINSTEIN PE试验中,与标准抗凝治疗相比,利伐沙班治疗静脉血栓栓塞(VTE)可提高患者满意度。这项针对利伐沙班治疗深静脉血栓形成的前瞻性、非干预性XALIA研究的子研究评估了在常规临床实践中是否也观察到这一情况。XALIA研究中接受利伐沙班或标准抗凝治疗的患者符合纳入该子研究的条件。治疗决策由医生自行决定。患者在随访期间完成了17项抗凝血治疗量表(ACTS,包括一个12项的负担子量表、一个3项的益处子量表以及每个子量表各一项总体项目)。主要分析采用倾向评分匹配集(PMS);调整后的安全性分析(ASAF)集用于验证目的。还进行了按随访就诊和亚组(包括年龄、性别和既往VTE情况)的分析。PMS-ACTS分析纳入了458例接受利伐沙班治疗的患者和434例接受标准抗凝治疗的患者。各治疗组的基线人口统计学和临床特征总体相似。与标准抗凝治疗相比,利伐沙班治疗使ACTS负担评分显著改善(最小二乘均值差异为2.4±0.4分;P<0.0001);利伐沙班治疗的ACTS益处评分在数值上更高(最小二乘均值差异为0.2±0.1分;P=0.2)。在各随访就诊和亚组中均出现了类似结果。ASAF-ACTS分析证实了这些结果。与III期分析一致,利伐沙班与ACTS负担评分改善相关;ACTS益处评分在数值上更有利于利伐沙班,尽管未达到统计学显著性。