title: Medication persistence and discontinuation of rivaroxaban and dabigatran etexilate among patients with non-valvular atrial fibrillation.
abstract: OBJECTIVE
  To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and dabigatran in the US.
  
  
  METHODS
  A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF on rivaroxaban or dabigatran between October 2010 and March 2013. The index date was the date of the first prescription of rivaroxaban or dabigatran. All patients had ≥6 months of data prior to the index date and were followed until the earliest of inpatient death, end of continuous enrollment, or end of the study period. Rivaroxaban patients were matched 1:1 with dabigatran patients using the propensity score matching technique. Cox proportional hazards models were employed to estimate the adjusted hazard ratios (aHRs) of non-persistence and discontinuation. Persistence was defined as absence of a refill gap of ≥60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up.
  
  
  RESULTS
  A total of 30,337 NVAF patients on rivaroxaban or dabigatran met the study criteria. All 7259 rivaroxaban patients were matched 1:1 to dabigatran patients. Compared with dabigatran users, rivaroxaban patients were 11% less likely to become non-persistent with therapy (aHR: 0.89, 95% CI 0.84-0.95) and 29% less likely to discontinue therapy (aHR: 0.71, 95% CI 0.66-0.77).
  
  
  CONCLUSIONS
  Claims data are subject to miscoding and inaccuracies. Refill data may not fully reflect actual medication taken. Confounding may remain even after propensity score matching and additional adjustments in model. Longer follow-up may produce more precise estimates of persistence and discontinuation.
  
  
  CONCLUSIONS
  This matched cohort analysis indicated that, compared to dabigatran, rivaroxaban was associated with better persistence and lower rates of discontinuation.
authors.affiliation: a a Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Winnie W
authors.initials: WW
authors.lastname: Nelson
authors.affiliation: b b Truven Health Analytics , Bethesda , MD , USA.
authors.forename: Xue
authors.initials: X
authors.lastname: Song
authors.affiliation: b b Truven Health Analytics , Bethesda , MD , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Thomson
authors.affiliation: b b Truven Health Analytics , Bethesda , MD , USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Smith
authors.affiliation: c c Department of Pharmacy Practice , University of Connecticut , Storrs , CT , USA.
authors.forename: Craig I
authors.initials: CI
authors.lastname: Coleman
authors.affiliation: d d Janssen Research and Development LLC , Raritan , USA.
authors.forename: C V
authors.initials: CV
authors.lastname: Damaraju
authors.affiliation: a a Janssen Scientific Affairs LLC , Raritan , NJ , USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Schein
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D000069604:Dabigatran / Q000008:administration & dosage / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Non-valvular atrial fibrillation; Persistence; Rivaroxaban; Warfarin