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Comparison of Treatment Persistence with Dabigatran or Rivaroxaban versus Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients: A Competing Risk Analysis in the French National Health Care Databases
| dc.rights.license | open | en_US |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | MAURA, Geric | |
| dc.contributor.author | BILLIONNET, C. | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | ALLA, Francois | |
| dc.contributor.author | GAGNE, J. J. | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | PARIENTE, Antoine
IDREF: 13395711X | |
| dc.date.accessioned | 2020-12-07T11:22:55Z | |
| dc.date.available | 2020-12-07T11:22:55Z | |
| dc.date.issued | 2018-01 | |
| dc.identifier.issn | 0277-0008 | en_US |
| dc.identifier.uri | https://oskar-bordeaux.fr/handle/20.500.12278/21324 | |
| dc.description.abstractEn | BACKGROUND: Direct oral anticoagulants (DOACs) have been proposed as a more convenient alternative to vitamin K antagonists (VKAs), which are commonly associated with poor treatment persistence in nonvalvular atrial fibrillation (nv-AF). METHODS: Using data from the French National Healthcare databases (Regime General, 50 million beneficiaries), a cohort study was conducted to compare the 1-year non-persistence rates in nv-AF patients initiating dabigatran (N=11,141) or rivaroxaban (N=11,126) versus VKA (N=11,998). Treatment discontinuation was defined as a switch between oral anticoagulant (OAC) classes or a 60-day gap with no medication coverage, with the additional criterion of no reimbursement for international normalized ratio monitoring during this gap for VKA patients. Considering death as a competing risk, differences between 1-year discontinuation rates were used to compare each DOAC versus VKA. 95% confidence intervals [CIs] were estimated via bootstrapping. Baseline patient characteristics were adjusted using inverse probability of treatment weighting. Subgroup analyses considered DOAC dose at initiation, age, risk of stroke, and bleeding. RESULTS: Adjusted 1-year discontinuation rates were higher for dabigatran than for VKA new users (36.8% vs 30.2%; difference: 6.6% [95% CI, 5.5 to 7.6]) and for rivaroxaban versus VKA new users (33.4% vs 30.4%; 3.0% [1.9 to 4.1]). Similar differences were found in all subgroup analyses, except in dabigatran and rivaroxaban patients <75 y (dabigatran vs VKA: 0.3% [-1.4 to 1.8]; rivaroxaban vs VKA: -2.6% [-4.3 to -0.9]) and dabigatran 150 mg new users (-1.1% [-3.1 to 0.7]). Consistent results were obtained when considering both switches between OAC classes and death as competing risks of treatment discontinuation. CONCLUSION: Results from this nationwide cohort study showed high non-persistence levels with all OACs and suggest that persistence with both dabigatran and rivaroxaban therapy is not better than persistence with VKA therapy. Hospitalizations for bleeding among non-persistent patients were unlikely to explain these high non-persistence rates. This article is protected by copyright. All rights reserved. | |
| dc.language.iso | EN | en_US |
| dc.subject.en | PharmacoEpi-Drugs | |
| dc.title.en | Comparison of Treatment Persistence with Dabigatran or Rivaroxaban versus Vitamin K Antagonist Oral Anticoagulants in Atrial Fibrillation Patients: A Competing Risk Analysis in the French National Health Care Databases | |
| dc.title.alternative | Pharmacotherapy | en_US |
| dc.type | Article de revue | en_US |
| dc.identifier.doi | 10.1002/phar.2046 | en_US |
| dc.subject.hal | Sciences du Vivant [q-bio]/Santé publique et épidémiologie | en_US |
| dc.identifier.pubmed | 29028119 | en_US |
| bordeaux.journal | Pharmacotherapy | en_US |
| bordeaux.page | 6-18 | en_US |
| bordeaux.volume | 38 | en_US |
| bordeaux.hal.laboratories | Bordeaux Population Health Research Center (BPH) - UMR 1219 | en_US |
| bordeaux.issue | 1 | en_US |
| bordeaux.institution | Université de Bordeaux | en_US |
| bordeaux.team | PharmacoEpi-Drugs | en_US |
| bordeaux.peerReviewed | oui | en_US |
| bordeaux.inpress | non | en_US |
| hal.identifier | hal-03043528 | |
| hal.version | 1 | |
| hal.date.transferred | 2020-12-07T11:22:59Z | |
| hal.export | true | |
| bordeaux.COinS | ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Pharmacotherapy&rft.date=2018-01&rft.volume=38&rft.issue=1&rft.spage=6-18&rft.epage=6-18&rft.eissn=0277-0008&rft.issn=0277-0008&rft.au=MAURA,%20Geric&BILLIONNET,%20C.&ALLA,%20Francois&GAGNE,%20J.%20J.&PARIENTE,%20Antoine&rft.genre=article |
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