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Published on: February 28, 2012
Adherence to a Novel Oral Anticoagulant Among Patients with Atrial Fibrillation
Meijia Zhou1, Hsien-Yen Chang, Jodi B Segal
1University of Pennsylvania Perelman School of Medicine, 2024 E. Monument St., Ste. 2502, Baltimore MD 21287. ssingh31@jhu.edu.
Insights
Patient adherence to dabigatran, a direct thrombin inhibitor for atrial fibrillation, was found to be low. Many patients were nonadherent or discontinued therapy within a year, highlighting a need for further research into adherence barriers.
Area of Science:
- Pharmacology and Therapeutics
- Cardiovascular Medicine
- Patient Adherence Research
Background:
- Dabigatran, a direct thrombin inhibitor, is FDA-approved for nonvalvular atrial fibrillation treatment.
- Limited data exists on patient adherence to dabigatran therapy.
Purpose of the Study:
- To assess patient adherence and persistence to dabigatran in adults diagnosed with atrial fibrillation.
- To identify patterns of dabigatran use and discontinuation over time.
Main Methods:
- Utilized IMS Health's LifeLink Health Plan Claims Database (2010-2012).
- Identified new users of dabigatran with atrial fibrillation and tracked adherence via Medication Possession Ratio (MPR).
- Assessed persistence by measuring gaps in drug possession (≥60 days).
Main Results:
- Among 2,713 patients using dabigatran alone, 41% were nonadherent (mean MPR 0.73), and 32% had significant gaps in therapy.
- Within 9-12 months, nonadherence rates increased to 47-49%, with similar discontinuation rates.
- Adherence and persistence rates were comparable for patients with incident atrial fibrillation.
Conclusions:
- Nonadherence to dabigatran is prevalent in atrial fibrillation patients.
- Further investigation is required to elucidate the underlying causes of poor adherence.
Background:
Dabigatran is a direct thrombin inhibitor approved by the FDA in October 2010 for the treatment of nonvalvular atrial fibrillation. Little is known regarding patient adherence to this therapy.
Objective:
To examine adherence and persistence to dabigatran among adults with atrial fibrillation.
Methods:
We used IMS Health's LifeLink Health Plan Claims Database from 2010 to 2012 to identify patients with atrial fibrillation who were new users of dabigatran. We derived adherence and persistence for continuously enrolled patients at 6 months, 9 months, and 12 months of follow-up. We measured adherence using the medication possession ratio (MPR), defined as individuals with MPRs of 0.80 or greater as adherent, and examined persistence by identifying individuals with gaps in drug possession of 60 days or greater.
Results:
Of 5,951 adults with atrial fibrillation who were new users of dabigatran, 49% had prevalent atrial fibrillation and at least 6 months of continuous follow-up. Of these, 89% used dabigatran as the only oral anticoagulant, whereas the remainder filled prescriptions for at least 1 other oral anticoagulant during the follow-up period. Among those using dabigatran alone (n = 2,713), the mean MPR was 0.73 (standard error = 0.30), 41% were nonadherent with therapy, and 32% had gaps of 60 days or greater. Among those observed for 9 (or 12) months who used dabigatran alone, rates of nonadherence were 47% (49%), whereas 48% (49%) discontinued therapy during follow-up. Rates of adherence and persistence were similar for patients with incident atrial fibrillation.
Conclusions:
Nonadherence to dabigatran was common among patients with atrial fibrillation. Future studies are needed to understand the reasons for nonadherence.
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