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. 2020 Jun 23;9(6):1969.
doi: 10.3390/jcm9061969.

Persistence with Anticoagulation for Atrial Fibrillation: Report from the GLORIA-AF Phase III 1-Year Follow-up

Monika Kozieł  1   2 , Michał Mazurek  2 , Christine Teutsch  3 , Hans-Christoph Diener  4 , Sergio J Dubner  5 , Jonathan L Halperin  6 , Chang-Sheng Ma  7 , Kenneth J Rothman  8 , Axel Brandes  9 , Miney Paquette  10 , Kristina Zint  11 , Lionel Riou França  11   12 , Shihai Lu  13 , Dorothee B Bartels  11   14 , Menno V Huisman  15 , Gregory Y H Lip  1   2   16
Affiliations

Persistence with Anticoagulation for Atrial Fibrillation: Report from the GLORIA-AF Phase III 1-Year Follow-up

Monika Kozieł et al. J Clin Med. .

Abstract

Background: We aimed to assess the extent to which drug persistence is better with non-vitamin K antagonist oral anticoagulants (NOACs) than vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients and to estimate the difference in therapy persistence depending on NOAC dosing regimen (once daily (QD) vs. twice daily (BID)).

Methods: Consecutive patients were followed for 1 year in phase III of the GLORIA-AF registry. Drug persistence was defined as the use of OAC without any discontinuation in >30 days or switching to alternative therapy.

Results: Among 21,109 eligible patients in phase III, 17,266 patients who were prescribed OAC at baseline and those who took ≥1 OAC dose were included. The 1-year proportion of patients receiving NOAC and VKA who persisted on treatment was 80% and 75%, respectively. The 1-year persistence with NOACs BID and NOACs QD was 81% and 80%, respectively. Female gender, hypertension, older age, alcohol use, permanent, asymptomatic, and minimally symptomatic AF were associated with better OAC persistence. Region, medication usage predisposing to bleeding, being a current smoker, treatment reimbursement, and proton pump inhibitors were associated with lower OAC persistence.

Conclusions: Drug persistence was higher with NOACs (1-year persistence was 80%) than with VKAs (75%). There was little difference in 1-year persistence between NOAC dosing regimens.

Keywords: GLORIA-AF; atrial fibrillation; dosing frequency; non-vitamin K antagonist oral anticoagulants; oral anticoagulants; vitamin K antagonists.

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Conflict of interest statement

Kozieł, Mazurek, and Rothman declare no conflicts of interest. Teutsch, Paquette, Zint, and Lu are employees of Boehringer Ingelheim. Bartels and Riou Franca were employees of Boehringer Ingelheim at the time of manuscript writing. Diener received honoraria for participation in clinical trials, contribution to advisory boards, or oral presentations from Abbott, Bayer Vital, BMS, Boehringer Ingelheim, Daiichi-Sankyo, Medtronic, Pfizer, Portola, Sanofi-Aventis, and WebMD Global. Financial support for research projects was provided by Boehringer Ingelheim. HCD chairs the Treatment Guidelines Committee of the German Society of Neurology and contributed to the EHRA and ESC guidelines for the treatment of AF. Dubner has received consultancy fees for serving as a steering committee member for Boehringer Ingelheim. He also holds research grants from Abbott. Halperin has engaged in consulting activities with Boehringer Ingelheim for advisory activities involving anticoagulants, and he is a member of the Executive Steering Committee of the GLORIA-AF Registry. Ma has received honoraria for lectures from AstraZeneca, Bayer HealthCare, Boehringer Ingelheim, Bristol-Myers Squibb, Johnson & Johnson, and Pfizer. Brandes has received lecture fees from Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, and MSD and research grants from Gilead and the Region of Southern Denmark and Zealand. Huisman reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Boehringer Ingelheim, Pfizer-BMS, Bayer HealthCare, Aspen, and Daiichi-Sankyo, outside the submitted work. Lip has been a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo. He has been a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. He did not directly receive any fees.

Figures

Figure 1
Figure 1
Drug persistence based on Kaplan–Meier estimator. Trimmed patients on VKAs and NOACs. NOACs, non-vitamin K antagonist oral anticoagulants; VKAs, vitamin K antagonists.
Figure 2
Figure 2
Drug persistence based on Kaplan–Meier estimator. Trimmed patients on NOACs once daily and NOACs twice daily. NOACs, non-vitamin K antagonist oral anticoagulants; VKAs, vitamin K antagonists.
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References

    1. Lip G., Freedman B., De Caterina R., Potpara T.S. Stroke prevention in atrial fibrillationast, present and future. Comparing the guidelines and practical decision-making. Thromb. Haemost. 2017;117:1230–1239. - PubMed
    1. Lip G.Y.H., Banerjee A., Boriani G., en Chiang C., Fargo R., Freedman B., Lane D.A., Ruff C.T., Turakhia M., Werring D., et al. Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report. CHEST. 2018;154:1121–1201. doi: 10.1016/j.chest.2018.07.040. - DOI - PubMed
    1. Paquette M., França L.R., Teutsch C., Diener H.-C., Lu S., Dubner S.J., Rothman J.K., Zint K., Halperin J.L., Huisman M.V., et al. Persistence With Dabigatran Therapy at 2 Years in Patients with Atrial Fibrillation. J. Am. Coll. Cardiol. 2017;70:1573–1583. doi: 10.1016/j.jacc.2017.07.793. - DOI - PubMed
    1. Vrijens B., Heidbuchel H. Non-vitamin K antagonist oral anticoagulants: Considerations on once- vs. twice-daily regimens and their potential impact on medication adherence. Europace. 2015;17:514–523. doi: 10.1093/europace/euu311. - DOI - PubMed
    1. Connolly S.J., Ezekowitz M.D., Yusuf S., Eikelboom J., Oldgren J., Parekh A., Pogue J., Reilly P.A., Themeles E., Varrone J., et al. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med. 2009;361:1139–1151. doi: 10.1056/NEJMoa0905561. - DOI - PubMed

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