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Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands
Objective: There is limited evidence on patients' adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation. Metho...
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Published in: | Current medical research and opinion 2018-10, Vol.34 (10), p.1839-1847 |
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container_title | Current medical research and opinion |
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creator | Jacobs, Maartje S. Schouten, Jeroen F. de Boer, Pieter T. Hoffmann, Mikael Levin, Lars-Åke Postma, Maarten J. |
description | Objective: There is limited evidence on patients' adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation.
Methods: Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR ≥0.8. Sensitivity analyses were performed using a MPR ≥0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen.
Results: A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]).
Limitations: The influence of selection bias introduced by the inclusion criterion of ≥2 dispensations covering at least 180 days could not be excluded.
Conclusions: This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen. |
doi_str_mv | 10.1080/03007995.2018.1459528 |
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Methods: Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR ≥0.8. Sensitivity analyses were performed using a MPR ≥0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen.
Results: A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]).
Limitations: The influence of selection bias introduced by the inclusion criterion of ≥2 dispensations covering at least 180 days could not be excluded.
Conclusions: This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen.</description><identifier>ISSN: 0300-7995</identifier><identifier>ISSN: 1473-4877</identifier><identifier>EISSN: 1473-4877</identifier><identifier>DOI: 10.1080/03007995.2018.1459528</identifier><identifier>PMID: 29598152</identifier><language>eng</language><publisher>England: Taylor & Francis</publisher><subject>Adherence ; anticoagulation ; apixaban ; dabigatran ; dosing regimen ; non-vitamin-K oral anticoagulants ; rivaroxaban</subject><ispartof>Current medical research and opinion, 2018-10, Vol.34 (10), p.1839-1847</ispartof><rights>2018 Informa UK Limited, trading as Taylor & Francis Group 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-d154cb4f68b2086df7703cf45bf8f88c0303454bf4ca07b631ba25832254b86c3</citedby><cites>FETCH-LOGICAL-c451t-d154cb4f68b2086df7703cf45bf8f88c0303454bf4ca07b631ba25832254b86c3</cites><orcidid>0000-0002-6185-4718 ; 0000-0002-6306-3653</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29598152$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-151809$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Jacobs, Maartje S.</creatorcontrib><creatorcontrib>Schouten, Jeroen F.</creatorcontrib><creatorcontrib>de Boer, Pieter T.</creatorcontrib><creatorcontrib>Hoffmann, Mikael</creatorcontrib><creatorcontrib>Levin, Lars-Åke</creatorcontrib><creatorcontrib>Postma, Maarten J.</creatorcontrib><title>Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands</title><title>Current medical research and opinion</title><addtitle>Curr Med Res Opin</addtitle><description>Objective: There is limited evidence on patients' adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation.
Methods: Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR ≥0.8. Sensitivity analyses were performed using a MPR ≥0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen.
Results: A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]).
Limitations: The influence of selection bias introduced by the inclusion criterion of ≥2 dispensations covering at least 180 days could not be excluded.
Conclusions: This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen.</description><subject>Adherence</subject><subject>anticoagulation</subject><subject>apixaban</subject><subject>dabigatran</subject><subject>dosing regimen</subject><subject>non-vitamin-K oral anticoagulants</subject><subject>rivaroxaban</subject><issn>0300-7995</issn><issn>1473-4877</issn><issn>1473-4877</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kctuFDEQRS0EIkPgE0BesunBz273jig8RQSLAFvLzxmjbnuw3YzyA3w3bs0kSzZ2lX1ula4uAC8x2mIk0BtEERrGkW8JwmKLGR85EY_ABrOBdkwMw2OwWZluhS7As1J-IYSJGMen4IKMfBSYkw34e-tMilblO6js3mUXjYM1wZhi9ydUNYfYfYEqVrVLMZQKU1bT2geT1G6ZWlVgiPCganBrfQx1D1XNoWE-6BymqX2luEK3R2ddbGoL697Br66duY2w5Tl44tVU3IvzfQl-fHj__fpTd_Pt4-frq5vOMI5rZzFnRjPfC02Q6K0fBkSNZ1x74YUwzTBlnGnPjEKD7inWinBBCWmPojf0EnSnueXoDouWhxzm5l0mFeS78PNKpryTU1gk5ligsfGvT_whp9-LK1XOoRjXPEWXliIJIogJ2ve0ofyEmpxKyc4_DMdIrpHJ-8jkGpk8R9Z0r84rFj07-6C6z6gBb09AiD7lWR1Tnqys6m5K2WcVTSiS_n_HP1Mqp-8</recordid><startdate>20181003</startdate><enddate>20181003</enddate><creator>Jacobs, Maartje S.</creator><creator>Schouten, Jeroen F.</creator><creator>de Boer, Pieter T.</creator><creator>Hoffmann, Mikael</creator><creator>Levin, Lars-Åke</creator><creator>Postma, Maarten J.</creator><general>Taylor & Francis</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DG8</scope><orcidid>https://orcid.org/0000-0002-6185-4718</orcidid><orcidid>https://orcid.org/0000-0002-6306-3653</orcidid></search><sort><creationdate>20181003</creationdate><title>Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands</title><author>Jacobs, Maartje S. ; Schouten, Jeroen F. ; de Boer, Pieter T. ; Hoffmann, Mikael ; Levin, Lars-Åke ; Postma, Maarten J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-d154cb4f68b2086df7703cf45bf8f88c0303454bf4ca07b631ba25832254b86c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adherence</topic><topic>anticoagulation</topic><topic>apixaban</topic><topic>dabigatran</topic><topic>dosing regimen</topic><topic>non-vitamin-K oral anticoagulants</topic><topic>rivaroxaban</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jacobs, Maartje S.</creatorcontrib><creatorcontrib>Schouten, Jeroen F.</creatorcontrib><creatorcontrib>de Boer, Pieter T.</creatorcontrib><creatorcontrib>Hoffmann, Mikael</creatorcontrib><creatorcontrib>Levin, Lars-Åke</creatorcontrib><creatorcontrib>Postma, Maarten J.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Linköpings universitet</collection><jtitle>Current medical research and opinion</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jacobs, Maartje S.</au><au>Schouten, Jeroen F.</au><au>de Boer, Pieter T.</au><au>Hoffmann, Mikael</au><au>Levin, Lars-Åke</au><au>Postma, Maarten J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands</atitle><jtitle>Current medical research and opinion</jtitle><addtitle>Curr Med Res Opin</addtitle><date>2018-10-03</date><risdate>2018</risdate><volume>34</volume><issue>10</issue><spage>1839</spage><epage>1847</epage><pages>1839-1847</pages><issn>0300-7995</issn><issn>1473-4877</issn><eissn>1473-4877</eissn><abstract>Objective: There is limited evidence on patients' adherence and the impact of the prescribed dosing regimen in non-vitamin-K oral anticoagulants (NOACs). We aimed to assess secondary adherence to NOACs and to determine the impact of the dosing regimen in patients with atrial fibrillation.
Methods: Patients using a NOAC between 2009 and 2013 were identified from the nation-wide Swedish Prescribed Drug Register and the Dutch regional IADB.nl database. Patients using a consistent dosage for at least 180 consecutive days were included. Adherence was calculated using the medication possession ratio (MPR) and adjusted for overlapping dates. Adherence was defined as a MPR ≥0.8. Sensitivity analyses were performed using a MPR ≥0.9. Logistic regression was performed to compare secondary adherence and to explore the influence of the dosing regimen.
Results: A total of 5254 Swedish and 430 Dutch NOAC users were included. The mean MPR was 96.0% (SD 7.8%) in Sweden and 95.1% (SD 10.1%) in the Netherlands. Multivariable logistic regression analysis showed that a twice daily regimen had a lower likelihood of being secondary adherent compared to a once daily regimen in Sweden (odds ratio [OR] 0.21 [95% CI 0.12-0.35]).
Limitations: The influence of selection bias introduced by the inclusion criterion of ≥2 dispensations covering at least 180 days could not be excluded.
Conclusions: This study demonstrated that secondary adherence was high in this specific setting among patients with at least two initial dispensations of a NOAC covering a minimum of 180 days. The use of NOACs in a once daily regimen showed higher adherence compared to a twice daily regimen.</abstract><cop>England</cop><pub>Taylor & Francis</pub><pmid>29598152</pmid><doi>10.1080/03007995.2018.1459528</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-6185-4718</orcidid><orcidid>https://orcid.org/0000-0002-6306-3653</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Adherence anticoagulation apixaban dabigatran dosing regimen non-vitamin-K oral anticoagulants rivaroxaban |
title | Secondary adherence to non-vitamin-K antagonist oral anticoagulants in patients with atrial fibrillation in Sweden and the Netherlands |
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