Treatment Adherence Compared between Nonvalvular AFib Patients Using XARELTO (rivaroxaban) and Those Using warfarin

Treatment Adherence Compared between Nonvalvular AFib Patients Using XARELTO (rivaroxaban) and Those Using warfarin

New data from a study published online in Current Medical Research and Opinion and co-authored by researchers at Janssen Pharmaceuticals, American distributor of XARELTO® (rivaroxaban), indicate that rivaroxaban is associated with significantly greater adherence rates for patients with nonvalvular atrial fibrillation (NVAF) as compared to warfarin.  Other oral anti-coagulant medications were not included in this comparison.

Medication non-adherence is known to lead to avoidable hospitalizations and other health care complications, contributing more than $300 billion to unnecessary overall health care costs, according to a report on medication adherence by the Pharmaceutical Research and Manufacturers of America (PhRMA) published in January 2011.  The PhRMA report estimates that three of every four Americans do not take their medication as directed.

These latest findings regarding anticoagulation treatment management were drawn from a retrospective cohort analysis done on a large, nationally representative U.S. claims database of patients with NVAF treated with rivaroxaban or warfarin from July 2010 to March 2013.  The results suggest patients taking XARELTO® were 37 percent more likely to persist with therapy and 46 percent less likely to discontinue therapy compared to those receiving warfarin.

The authors, while concluding that the analysis clearly reflected higher medication persistence and lower discontinuation rates with rivaroxaban, acknowledge the following study limitations which could have affected these results in either direction: (1) Claims data may have contained inaccuracies and miscoding. (2) Confounding may remain even after propensity score matching and additional adjustments in model. (3) Refill data may not fully reflect actual medication use. The authors also note that longer follow-up may produce more precise estimates of persistence and discontinuation.

Read More: http://informahealthcare.com/doi/abs/10.1185/03007995.2014.933577

Winnie Nelson, lead study author and Director of Health Economics & Outcomes Research at Janssen Pharmaceuticals states:

“Medication non-adherence has been shown to have a damaging effect on patient outcomes and the healthcare system as a whole. These new findings and other data suggest XARELTO®, a once-daily anticoagulant option without the need for routine blood monitoring, may be conducive to greater patient adherence.”

With estimates that as many as 50% of those prescribed anticoagulation medication no longer adhering to their treatment after a year, this study suggests that the newer wave of oral anticoagulants may offer additional convenience that reinforces patients to maintain their regimens.

The PhRMA paper cited above notes the following predictors of poor patient treatment adherence, as adapted from: L. Osterberg and T. Blaschke. “Adherence to Medicine,” New England Journal of Medicine, August 2005.

Patient-Related Limitations:

  • Psychological problems, particularly depression
  • Cognitive impairment
  • Asymptomatic disease
  • Inadequate follow-up or discharge planning
  • Side effects of medicine
  • Patient lacks belief in benefit of treatment
  • Patient lacks insight into the illness 

Barriers to Care or Medicine:

  • Poor relationship between patient and provider
  • Missed appointments
  • Lack of health insurance
  • Cost of copayment or coinsurance
  • Complexity of treatment
  • Access restrictions (e.g., formularies, utilization management)


DISCLOSURE: Janssen Pharmaceuticals is among the corporate sponsors that support the work of the NBCA.

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