Prescribing Patterns and Outcomes of Edoxaban in Atrial Fibrillation: One-Year Data from the Global ETNA-AF Program

Non-recommended dosing occurs in ~25-50% of non-vitamin K antagonist oral anticoagulant prescriptions, with limited data for edoxaban. We analyzed edoxaban dosing patterns in atrial fibrillation patients from the Global ETNA-AF program, relating patterns to baseline characteristics and 1-year clinic...

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Bibliographic Details
Published in:Journal of clinical medicine 2023-02, Vol.12 (5), p.1870
Main Authors: Chao, Tze-Fan, Unverdorben, Martin, Kirchhof, Paulus, Koretsune, Yukihiro, Yamashita, Takeshi, Crozier, Robert A, Pecen, Ladislav, Chen, Cathy, Borrow, Amanda P, De Caterina, Raffaele
Format: Article
Language:English
Subjects:
Atrial fibrillation
Cardiac arrhythmia
Clinical medicine
Clinical outcomes
Diabetes
Diagnosis
Drug therapy
Forecasts and trends
Heart attacks
Heart failure
Patient outcomes
Patients
Prescription writing
Stroke
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Summary:Non-recommended dosing occurs in ~25-50% of non-vitamin K antagonist oral anticoagulant prescriptions, with limited data for edoxaban. We analyzed edoxaban dosing patterns in atrial fibrillation patients from the Global ETNA-AF program, relating patterns to baseline characteristics and 1-year clinical outcomes. The following dosing groups were compared: non-recommended 60 mg ("overdosed") vs. recommended 30 mg; non-recommended 30 mg ("underdosed") vs. recommended 60 mg. Most (22,166/26,823; 82.6%) patients received recommended doses. Non-recommended dosing was more frequent near label-specified dose-reduction thresholds. Ischemic stroke (IS; HR 0.85, 95% CI 0.50-1.47; = 0.6) and major bleeding (MB; HR 1.47, 95% CI 0.97-2.71; = 0.07) did not differ between recommended 60 mg and "underdosed" groups, whereas all-cause (HR 1.61, 95% CI 1.23-2.08; = 0.0003) and cardiovascular deaths (HR 1.61, 95% CI 1.11-2.38; = 0.01) were higher in the "underdosed" group. Compared with recommended 30 mg, the "overdosed" group had lower IS (HR 0.51, 95% CI 0.28-0.98; = 0.04) and all-cause death (HR 0.74, 95% CI 0.55-0.98; = 0.03) without higher MB (HR 0.74, 95% CI 0.46-1.22; = 0.2). In conclusion: non-recommended dosing was infrequent, but more common near dose-reduction thresholds. "Underdosing" was not associated with better clinical outcomes. The "overdosed" group had lower IS and all-cause death without higher MB.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm12051870