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September 16, 2015
Apixaban Adherence Not Improved by Patient
Education Program London, UK—An education program did not improve adherence to the oral anticoagulant apixaban for patients with atrial fibrillation (AF) compared to those who received no education program, according to a new study. Still, the presentation at the European Society of Cardiology (ESC) 2015 Congress in London, suggested the results were “quite encouraging,” according to Gilles Montalescot, MD, PhD, from the Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriere, in Paris, France. The results were from the international, randomized Eliquis Adherence in Non-Valvular Atrial Fibrillation (AEGEAN) trial, sponsored by Bristol-Myers Squibb. “We used the best possible tools for the educational program, including the usual staff and procedures of the anticoagulation clinics, and all of this was useless,” Montalescot said in an ESC press release. “However, the trial showed very good adherence to apixaban, leaving little room for improvement with an educational program, suggesting one more advantage of prescribing non-vitamin K antagonists (VKA) over VKAs in that there is apparently no need for additional education and information.” While VKAs such as warfarin are highly effective for stroke prevention in AF, reducing the risk by about two-thirds, the oral anticoagulants also have some disadvantages, according to the presentation. Those include a narrow therapeutic range, extensive drug and food interactions, frequent bleeding complications, and the need for frequent International Normalized Ratio (INR) monitoring and dose adjustments, Montalescot said. On the other hand, apixaban, as with other non–VKAs, has fewer food and drug interactions compared with VKAs and does not require routine monitoring, he added, noting that lack of regular testing also can make it more difficult to assure that patients are following the drug regimen. The AEGEAN trial seeks ways to improve adherence. The study included 579 AF patients treated with apixaban who received an educational program or 583 patients offered usual information about the disease and treatment. Researchers measured the differences in two outcomes: treatment adherence, defined as continuous twice-daily dosing, with an occasional missed dose allowed, and treatment persistence, defined as absence of discontinuation for 30 consecutive days over a 6-month observational period. Participants in the educational program received a patient information booklet explaining AF and anticoagulant treatment for stroke prevention, reminder tools such as a key ring and mobile phone alerts, and access to a virtual clinic utilizing staff from existing VKA monitoring clinics. Medication adherence was measured using an electronic device that holds a blister pack of pills and records each time the pack is removed. At 24 weeks, the adherence rate was 88.5% in the control group and 88.3% in the education group. Persistence rates, meanwhile, were 90.5% and 91.1% respectively. “Future studies may want to test more aggressive and more costly educational programs, but in the meantime the adherence and persistence rates we measured are quite reassuring with the common practice and usual mode of prescription of this medication,” concluded Montalescot.
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