One in ten patients with nonvalvular atrial fibrillation (NVAF) prescribed direct oral anticoagulants (DOACs) failed to take their first prescription, according to a new study published in the Journal of Managed Care + Specialty Pharmacy.
DOACs are commonly prescribed to limit the risk of stroke among NVAF patients, the study's authors explained, and nonadherence can have grave consequences for those individuals. However, they added, few studies have examined nonadherence rates found in real-world data.
The team tracked data from 12,257 patients with NVAF who were treated from January 2009 to December 2015 in Spain. Fifty-three percent of the patients were men, and the mean patient age was 74.6 years old.
Overall, primary nonadherence, defined as never collecting their first prescription, was seen in 10.4% of those patients.
The authors found that apixaban was associated with the highest rate of primary nonadherence (12.8%). That was followed by rivaroxaban (10.8%) and dabigatran (8.6%).
Also, being nonadherent was more common among patients under the age of 65.
The team also found that nonadherent patients faced a greater risk of chronic kidney disease, but a lower prevalence of diabetes, hypertension or stroke/transient ischemic attack.
“These results highlight a key opportunity to design interventions targeting primary nonadherence,” wrote lead author Alethea Charlton, MPharm, with Hospital Vall d’Hebron in Spain, and colleagues. "Moreover, primary nonadherent patients may never visit the community pharmacies where many adherence interventions currently take place.”
Read the full study here.