Division of Cardiology, Department of Internal Medicine, Dankook University, Chung Nam, South Korea.
Pharmaceutical Economics, Big Data Analysis & Policy, College of Pharmacy, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, South Korea.
Adv Ther. 2022 Jul;39(7):3112-3130. doi: 10.1007/s12325-022-02151-z. Epub 2022 May 7.
Treatment persistence for anticoagulant therapy is important in preventing thromboembolism in nonvalvular atrial fibrillation (NVAF) patients. Understanding drug utilization pattern and treatment changes in oral anticoagulant (OAC) users may facilite better NVAF management. Thus, our study aimed to examine OAC treatment patterns preceding events leading to switch or discontinuation and medication adherence in Korean NVAF patients.
We conducted a drug utilization study on all Korean patients with atrial fibrillation (AF) newly prescribed OACs between July 2015 and November 2016 using the national claims data. We assessed treatment changes such as switching and discontinuation from index OAC and relevant events preceding the change and examined patient characteristics as predictors of changes that occurred among OAC users. Medication adherence was compared among OAC users by calculating the medication possession ratio (MPR).
A total of 48,389 NVAF patients were identified who initiated OACs within the study period. Most initiated nonvitamin K antagonist oral anticoagulants (NOACs) (22% apixaban, 24% dabigatran, 37% rivaroxaban), and 18% initiated warfarin. The frequency of switch to another OAC was 8.8% for apixaban, 16.1% for dabigatran, 6.6% for rivaroxaban, and 19.1% for warfarin. The frequency of discontinuation was lower for apixaban (22.9%), dabigatran (26.3%), and rivaroxaban (25.7%) than warfarin (31.6%). Compared to warfarin, NOAC users were less likely to switch treatment. Thromboembolic event was the most common clinical event preceding switch from warfarin to NOAC and from NOAC to warfarin. Discontinuation of OAC was often preceded by a bleeding event. Patients who initiated apixaban showed significantly higher mean MPR compared to those on dabigatran and warfarin.
In real-world practice in Korea, we have observed treatment change to be common in OAC users. Our results indicate better medication adherence with NOACs than with warfarin. (ClinicalTrials.gov registration number NCT03572972).
在非瓣膜性心房颤动 (NVAF) 患者中，抗凝治疗的持续治疗非常重要。了解口服抗凝剂 (OAC) 使用者的药物使用模式和治疗变化可能有助于更好地管理 NVAF。因此，我们的研究旨在检查导致切换或停药的事件之前 OAC 治疗模式以及韩国 NVAF 患者的药物依从性。
我们使用国家索赔数据对 2015 年 7 月至 2016 年 11 月期间新处方 OAC 的所有韩国房颤患者进行了一项药物利用研究。我们评估了从索引 OAC 开始的治疗变化，如切换和停药，以及变化之前的相关事件，并检查了 OAC 使用者变化的预测因素。通过计算药物持有率 (MPR) 比较了 OAC 使用者的药物依从性。
共确定了 48389 名在研究期间开始使用 OAC 的 NVAF 患者。大多数患者开始使用非维生素 K 拮抗剂口服抗凝剂 (NOAC)（22%阿哌沙班、24%达比加群、37%利伐沙班），18%患者开始使用华法林。阿哌沙班的转换率为 8.8%，达比加群为 16.1%，利伐沙班为 6.6%，华法林为 19.1%。阿哌沙班（22.9%）、达比加群（26.3%）和利伐沙班（25.7%）的停药率低于华法林（31.6%）。与华法林相比，NOAC 使用者更不可能进行治疗转换。血栓栓塞事件是华法林转换为 NOAC 和 NOAC 转换为华法林之前最常见的临床事件。OAC 停药常常发生在出血事件之前。开始使用阿哌沙班的患者的平均 MPR 明显高于达比加群和华法林。
在韩国的实际实践中，我们观察到 OAC 使用者的治疗变化很常见。我们的结果表明，NOAC 比华法林具有更好的药物依从性。（临床试验注册号 NCT03572972）。
