Rivaroxaban was found to be noninferior to warfarin in routine clinical care: A retrospective noninferiority cohort replication study
| Autor: | Althunian, Turki A., de Boer, Anthonius, Groenwold, Rolf H.H., Rengerink, Katrien O., Souverein, Patrick C., Klungel, Olaf H., Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology |
|---|---|
| Přispěvatelé: | Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
pharmacoepidemiology Epidemiology Embolism real-world evidence methodology 030226 pharmacology & pharmacy real‐world evidence methodology effectivness Cohort Studies 0302 clinical medicine Rivaroxaban Atrial Fibrillation electronic health care records Original Report Pharmacology (medical) 030212 general & internal medicine Stroke Aged 80 and over methodology Atrial fibrillation Pharmacoepidemiology Middle Aged Treatment Outcome Cohort Female Cohort study medicine.drug medicine.medical_specialty Hemorrhage 03 medical and health sciences Internal medicine Original Reports medicine Humans real-world evidence observational studies Aged Retrospective Studies business.industry Warfarin Anticoagulants medicine.disease noninferiority business Factor Xa Inhibitors Follow-Up Studies |
| Zdroj: | Pharmacoepidemiology and Drug Safety Pharmacoepidemiology and Drug Safety, 29(10), 1263. John Wiley and Sons Ltd |
| ISSN: | 1099-1557 1053-8569 |
| Popis: | Purpose To compare the effectiveness and safety of a drug in daily practice with the outcomes of a target non‐inferiority trial by rigorously mimickingin an observational study the trial's design features. Methods This cohort study was conducted using the British Clinical Practice Research Datalink (CPRD) to emulate the ROCKET AF (Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial. Patients with atrial fibrillation who were newly prescribed (>=12 months of no use) either rivaroxaban or warfarinfrom October 2008 to December 2017 were included. Non‐inferiority of rivaroxaban to warfarin in the prevention of stroke or systemic embolism was assessed in different analysis populations (intention‐to‐treat [ITT], per‐protocol [PP], and as‐treated populations) using a hazardratio (HR) of 1.46 as the non‐inferiority margin. Major bleeding (safety outcome) was also assessed and compared to that of the target trial. All outcomes were analyzed using Cox‐proportional hazard analyses. Results We included 25,473 incident users of rivaroxaban (n=4,008) or warfarin(n=21,465). Similar to the trial, non‐inferiority in the primary out come was demonstrated in all three analysis populations: HR=1.04 (95%CI 0.84 to 1.30) (ITT), HR=0.98 (95%CI 0.70 to 1.38) (PP), and HR=1.11 (95%CI 0.86 to 1.42) (as‐treated). Risk of major bleeding was also similar to the target trial. Conclusion The results of this study provide supportive evidence to the effectiveness of rivaroxaban and adds knowledge on the usefulness of emulating a non‐inferiority trial to assess drug effectiveness. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text