Sabaté M, Vidal X, Ballarin E, Rottenkolber M, Schmiedl S, Grave B, Huerta C, Martin-Merino E, Montero D, Leon-Muñoz L M, Gasse C, Moore N, Droz C, Lassalle R, Aakjær M, Andersen M, De Bruin M L, Souverein P, Klungel O H, Gardarsdottir H, Ibáñez L
Fundació Institut Català de Farmacologia (FICF), Barcelona, Spain.
Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Front Pharmacol. 2021 Nov 3;12:682890. doi: 10.3389/fphar.2021.682890. eCollection 2021.
To describe and compare the adherence to different direct oral anticoagulants (DOACs) in eight European databases representing six countries. Longitudinal drug utilization study of new users (≥18 years) of DOACs (dabigatran, rivaroxaban, apixaban) with a diagnosis of non-valvular atrial fibrillation (2008-2015). Adherence was examined by estimating persistence, switching, and discontinuation rates at 12 months. Primary non-adherence was estimated in BIFAP and SIDIAP databases. The highest persistence rate was seen for apixaban in the CPRD database (81%) and the lowest for dabigatran in the Mondriaan database (22%). The switching rate for all DOACs ranged from 2.4 to 13.1% (Mondriaan and EGB databases, respectively). Dabigatran had the highest switching rate from 5.0 to 20.0% (Mondriaan and EGB databases, respectively). The discontinuation rate for all DOACs ranged from 16.0 to 63.9% (CPRD and Bavarian CD databases, respectively). Dabigatran had the highest rate of discontinuers, except in the Bavarian CD and AOK NORDWEST databases, ranging from 23.2 to 64.6% (CPRD and Mondriaan databases, respectively). Combined primary non-adherence for examined DOACs was 11.1% in BIFAP and 14.0% in SIDIAP. There were differences in population coverage and in the type of drug data source among the databases. Despite the differences in the characteristics of the databases and in demographic and baseline characteristics of the included population that could explain some of the observed discrepancies, we can observe a similar pattern throughout the databases. Apixaban was the DOAC with the highest persistence. Dabigatran had the highest proportion of discontinuers and switchers at 12 months in most databases (EMA/2015/27/PH).
描述并比较六个国家八个欧洲数据库中不同直接口服抗凝剂（DOACs）的依从性。对诊断为非瓣膜性心房颤动的DOACs（达比加群、利伐沙班、阿哌沙班）新使用者（≥18岁）进行纵向药物利用研究（2008 - 2015年）。通过估计12个月时的持续用药率、换药率和停药率来检查依从性。在BIFAP和SIDIAP数据库中估计初始非依从性。在CPRD数据库中阿哌沙班的持续用药率最高（81%），在Mondriaan数据库中达比加群的持续用药率最低（22%）。所有DOACs的换药率在2.4%至13.1%之间（分别在Mondriaan和EGB数据库）。达比加群的换药率最高，在Mondriaan和EGB数据库中分别为5.0%至20.0%。所有DOACs的停药率在16.0%至63.9%之间（分别在CPRD和巴伐利亚CD数据库）。除了在巴伐利亚CD和AOK NORDWEST数据库外，达比加群的停药者比例最高，在CPRD和Mondriaan数据库中分别为23.2%至64.6%。在所检查的DOACs中，BIFAP数据库的初始非依从性综合为11.1%，SIDIAP数据库为14.0%。各数据库在人群覆盖范围和药物数据源类型方面存在差异。尽管数据库特征以及纳入人群的人口统计学和基线特征存在差异，这些差异可以解释一些观察到的差异，但我们在所有数据库中都能观察到类似的模式。阿哌沙班是持续用药率最高的DOAC。在大多数数据库中（EMA/2015/27/PH），达比加群在12个月时的停药者和换药者比例最高。
