(P-314) Time Trends in Patient Characteristics of New Rivaroxaban (RVX) Users with Atrial Fibrillation (AF) Across Four Countries

Background: Use of RVX, a direct oral anticoagulant, for stroke prevention in AF (SPAF) has been increasing, gradually replacing vitamin K antagonists, the former standard of care. Reasons to prescribe RVX and underlying patient profiles changed over time. As patient characteristics have impact on safety and effectiveness, knowledge of their temporal trends is required for overall assessment.

Objectives: To describe time-trends of patient characteristics of new RVX users in the SPAF indication from 2011 (approval) to 2017 in four European countries.

Methods: The study was based on data from IQVIA Medical Research Data (IMRD) in the UK, the German Pharmacoepidemiological Research Database (GePaRD), the PHARMO Database Network in the Netherlands and Swedish national health registries. We selected a cohort of new RVX users with (i) a first dispensing of RVX between 2011 and 2017 (2016 for GePaRD), (ii) ≥2 years of age, and (iii) a diagnosis of AF.

Results: Overall 173.739 new RVX users were identified. The proportion of new RVX users who used other oral anticoagulants before RVX decreased between 2011/2 and 2016/7 in the UK (66% to 30%), Germany (49% to 24%), the Netherlands (32% to 15%), and increased in Sweden from 8% to 14%. In all four countries, the proportion of males or mean age (74, 74, 70, 75, resp.) did not change over time. The proportion of patients with a history of ischemic stroke or transient ischemic attack decreased in the UK (15/15% to 10/8%) and Germany (22/14% to 16/12%). The proportion of patients with a history of intracranial bleeding decreased in Sweden (3% to 2%) and Germany (2% to 1%) and the proportion of patients with a history of gastrointestinal bleedings remained stable over the years. Polypharmacy (≥ 5 medications) decreased in all three countries where it was assessed: 81% to 75% in the UK, 67% to 51% in Germany, and 75% to 63% in the Netherlands. The use of antiarrhythmic medication at baseline decreased in all four countries: 17% to 12% in the UK, 14% to 8% in Germany, 17% to 5% in the Netherlands and 12% to 3% in Sweden. A decrease in the proportion of antiplatelet user at baseline was observed in Sweden (49% to 32%), the UK (38% to 33%) and in the Netherlands (32% to 23%), whereas it remained stable in Germany (12 %).

Conclusions: Characteristics of new RVX users for SPAF changed between 2011 and 2017, but no clear pattern was observed. Proportion of patients with a previous history of ischemic stroke decreased in two countries, whereas the proportion of patients with a history of bleeding remained stable for most entities and countries. This has to be taken into account when assessing overall risk and effectiveness and comparing results from different studies.