OBJECTIVES:

The objective of the study was to compare treatment adherence and persistence to edoxaban with other non-vitamin K antagonist oral anticoagulants (NOAC)—apixaban, dabigatran, rivaroxaban, and vitamin K antagonists (VKA)—in non-valvular atrial fibrillation (NVAF) patients in Germany.

METHODS:

Using data from the German health insurance database (Gesundheitsforen Leipzig database with nationally representative sample), a retrospective cohort study was conducted to compare 6-month adherence, measured as proportion of days covered (PDC), and persistence in NOAC-naïve NVAF patients initiating oral anticoagulant therapy between January 2014 and June 2017. Treatment discontinuation was defined as a prescription supply gap of ≥ 90 days. Propensity score matching was applied to control for differences in baseline characteristics.

RESULTS:

A total of 1,236 edoxaban patients were matched with patients treated with apixaban, dabigatran, rivaroxaban, and VKA. After matching, the proportion of patients with PDC ≥ 80% was significantly higher for edoxaban versus apixaban (63.0% versus 52.0%), dabigatran (62.0% versus 41.4%), and VKA (62.9% versus 45.2%) (all p < 0.05); it was comparable between edoxaban and rivaroxaban (63.0% vs. 66.6%, p = 0.07). Six-month persistence rates were significantly higher for edoxaban versus dabigatran (75.8% versus 66.3%), rivaroxaban (77.4% vs. 73.1%) and VKA (77.4% versus 58.6%) (all p < 0.05); it was numerically higher in edoxaban group compared to apixaban (77.4% versus 75.8%, p = 0.37).

CONCLUSIONS:

Edoxaban was associated with significantly better adherence in NVAF patients compared to apixaban, dabigatran, and VKA possibly because edoxaban is dosed once rather than twice daily and does not require routine blood tests. Edoxaban patients also had higher persistence compared to dabigatran, rivaroxaban, and VKA. Adherence and persistence should be considered in treatment selection to improve patient care.