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It is the duration of time from initiation to discontinuation of therapy. It is distinct from adherence, which is the extent to which patients conform to physicians’ recommendations relating to timing, dose and frequency of medication taking.3
*In ARISTOTLE, 25.3% of the patients discontinued in the Eliquis® group, with 3.6% of the discontinuations due to death, vs. 27.5% of patients discontinuing in the warfarin group, with 3.8% due to death (P=0.001).2
Time frame: 22 August 2011 - 31 December 2015.
Population: A total of 54,321 NOAC-naïve patients with NVAF were identified from nationwide administrative registries.
Analysis: Retrospective cohort analysis. HRs for non-persistence were calculated using Eliquis® as reference. Cox regression models were adjusted for age, sex, calendar year, variables in the CHA2DS2-VASc and HAS-BLED scores, and switch of OAC treatment. For all analyses, Eliquis® was used as reference.
†Non-persistence was defined as no claim for the same as well as for any OAC for at least 30 days following the end of last OAC treatment period (i.e., a treatment gap of more than 30 days).5
‡Persistence was calculated as the proportions of patients on each drug who were alive at the end of 6-month intervals until December 31, 2014, and who claimed the treatment in question during this interval.6
ARISTOTLE: Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; CHA2DS2-VASc: congestive heart failure, hypertension, aged ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, aged 65-74 years, sex category; CI: confidence interval; HAS-BLED: hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly >65 years, drugs/alcohol concomitantly; INR: International Normalized Ratio; NOAC: non-vitamin K antagonist oral anticoagulant; OAC: oral anticoagulant; OR: odds ratio; US: United States.
References: 1. Eliquis 2.5 mg/ 5 mg Egyptian Drug Authority approved leaflet 17/08/2022. Revision Date: February 2022. 2. Granger CB, Alexander JH, McMurray JJ, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365(11):981-992. 3. Cramer JA, Roy A, Burrell A, et al.Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44-7. 4. Yao X, Abraham NS, Alexander GC, et al. Effect of adherence to oral anticoagulants on risk of stroke and major bleeding among patients with atrial fibrillation. J Am Heart Assoc. 2016;5(2). pii: e003074. 5. Lamberts M, Staerk L, Olesen JB, et al. Major bleeding complications and persistence with oral anticoagulation in non-valvular atrial fibrillation: contemporary findings in real-life danish patients. J Am Heart Assoc. 2017;6(2). pii: e004517. 6. Forslund T, Wettermark B, Hjemdahl P. Comparison of treatment persistence with different oral anticoagulants in patients with atrial fibrillation. Eur J Clin Pharmacol. 2016;72(3):329-338.
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