Persistence Rates Higher With Dabigatran Than Warfarin

August 08, 2013

WALTHAM, MA — An analysis of US administrative data suggests that patients with nonvalvular atrial fibrillation (AF) treated withdabigatran etexilate (Pradaxa, Boehringer Ingelheim) are more persistent in taking their medication than patients treated with warfarin[1].

Published online August 6, 2013 in Circulation: Cardiovascular Quality and Outcomes, the study showed that 63% of patients prescribed dabigatran were taking their drug when measured at one year compared with 39% of patients who were prescribed warfarin.

"In this retrospective study of newly diagnosed nonvalvular AF patients initiating treatment with dabigatran vs warfarin using a large claims database, we found consistently higher persistence with therapy in those treated with dabigatran at six, nine, and 12 months," write lead author Dr Martin Zalesak (Trinity Partners, Waltham, MA) and colleagues. "As in previous studies of oral anticoagulant therapy, we found persistence to increase with increasing patient's age and stroke risk and persistence to decrease with increasing risk of hemorrhage."

In the study, persistence was defined as the duration of time from the initiation of treatment to discontinuation of therapy. If patients failed to refill a prescription for either drug within an appropriate period of time (a time gap of 60 days was used for the analysis), they were considered as having stopped treatment. Patients who switched from one therapy to the other were also considered discontinued.

In the propensity-matched analysis, 1745 patients identified in the US Department of Defense claims database taking dabigatran for nonvalvular AF were compared with 1745 patients prescribed warfarin. Using the 60-day permissible medication gap, the rate of persistence for dabigatran-treated patients was 72% at six months compared with 53% among the warfarin patients. At one year, the respective persistence rates were 63% and 39%, as noted.

"In addition to offering superior stroke risk reduction with no increase in concomitant bleed risk, dabigatran may, therefore, also contribute to improved outcomes through increasing patients' persistence with therapy," conclude the authors."

Boehringer Ingelheim funded the analysis. Zalesak is an employee of Trinity Partners, which was contracted by Boehringer Ingelheim to work in collaboration on this study. Disclosures for the coauthors are listed in the paper.

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