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Real-World Data on Rivaroxaban vs. Warfarin

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CSWN talks with Winnie W. Nelson, PharmD, director of Health Economics and Outcomes at Janssen Scientific Affairs, LLC, about comparative data on rivaroxaban and warfarin. This interview was conducted at AHA 2013 in Dallas.

From previous trials we certainly know that rivaroxaban is not inferior to warfarin in a variety of settings for preventing stroke and systemic or systemic embolism and patients with non valvular atrial fibrillation here at hae we have some larger real world experience to draw on now which is always nice and i am with the winnie w nelson pharmd janssen scientific

Affairs and she’s the director of the health economics and outcomes research let’s look at this real world data for a second first off there’s the first one is comparative effectiveness and safety of rivaroxaban and warfarin in the nvaf population and you’ve got about 3,700 people i think 13,000 warfarin patients i mean this is a pretty large analysis where did

The data come from first before we talk about the final results yes the data source is called symphony is a database that is accumulated from providers that is sending a billing claim to the insurance and we get this information that came from a very broad population in the us so they came from hospital they came from clinics and also pharmacy and the patient type

Included patients who are insured by a commercial insurance or medicare or medicaid now you’re comparing the two types of drug use here and were these really comparable characteristics populations when you’re looking at them yes and the way we do it is to match these patients so we have one every one of our red rocks plantation are matched with up to four warfarin

Patients based on the characteristics and these characteristics include their demographics new age male-female and the clinical characteristics including comorbidities so what kind of other diseases they they may have so that way we can be sure that these two populations are comparable so we’ve got the clinical trial data now real world data what did you find yeah

Major finding is that the clinical endpoints that we track which include stroke system embolism bleeding and venous thromboembolism they are not significantly different between a oops but the other endpoint that we track which is in that hearings endpoint we show that patients weren’t taking rivaroxaban tend to be more persistent with the treatment than warfarin and

The reason probably would be because they don’t need the monitoring well in this study within we have no way to find out the reason because we these are billing information and so that would be something that is very worthwhile for research in the future but it’s kind of exciting that you know you’ve got an equal drug and there’s more adherence to the medication

In this particular study which is a large study adherence is very important for these patients for afib patients they need to take anticoagulant for the rest of their lives so being persistent with the therapy is paramount to their care and the health now the second one is real interesting to hospital length of stay does rivaroxaban reduce inpatient stay compared

To warfarin among patients with nvaf and here it’s like 2009 patients under rivaroxaban 11,000 on warfarin what did you find here yes the finding is that patients who were given the rivaroxaban in the hospital tend to be discharged soon err and we have a median difference of one day and that is quite important in the sense that patients get to go home sooner if

Perhaps if the choice of anticoagulant is different what we also don’t know why this is another thing that we couldn’t tell exactly from the data set which is observe that those who were given rivaroxaban tend to be discharged sooner it is important in the sense that longer hospitalization come with different kind of risks and it certainly could come with a cost as

Well what would i mean i’m trying to even think of what the mechanism by be or why it might any theories well we thought that perhaps patients need to be stabilized on warfarin and get their inr tested during the hospital stay and that added to the length of stay that’s phenomenal anything else that you want to talk about in terms of these two studies i mean that

It’s really good to get some real-world data out and to find out what’s happening with these patients in in a setting like that yeah real world data we feel it’s important to come clinical trial setting because number one we are looking at the the information from a more diverse population than the cocoa trial it is collected when patients are treating during

Routine care setting and finally we are also looking at endpoints that are not available in the clinical trial so four hours will be persistence and link to stay we encourage that our colleagues physicians will talk to the patient about their needs when choosing anticoagulant that conversation is very important in picking the most appropriate option refer on seban

Is the most studied factor today inhibitor and it is also the the anticoagulant with the broadest indication so i hope that when the physician is choosing and choosing anticoagulant with a patient they will take into consideration these real world findings such as persistence rate and length of stay those are two very important findings so thank you very much for

Joining us and for additional information from the aah a meeting please make sure you check us out online and in print and for cardio source world news i’m executive editor rick mcguire you

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Real-World Data on Rivaroxaban vs. Warfarin By CSWNews