Adherence to medication and characteristics of Japanese patients with non-valvular atrial fibrillation

Suzuki, Tsuyoshi; Shiga, Tsuyoshi; Omori, Hisako; Takeuchi, Fujio; Nishimura, Kazuhiko; Hagiwara, Nobuhisa

doi:10.1016/j.jjcc.2016.11.009

Cited by 27 publications

(20 citation statements)

References 39 publications

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“…Although MPR is an indirect estimate of "true" adherence, our results suggest that overall adherence for warfarin is optimal in the Japanese population, showing a higher rate of adherence than reports from other countries. 19,20) The reason for high adherence in the Japanese population is uncertain, but our results are comparable with those of another recent report from Japan. 21) Suzuki et al analyzed self-reported questionnaires among 378 Japanese patients with non-valvular AF (77% warfarin users) and found that 86% of patients were adherent to anticoagulation therapy.…”

Section: Discussionsupporting

confidence: 87%

“…19,20) The reason for high adherence in the Japanese population is uncertain, but our results are comparable with those of another recent report from Japan. 21) Suzuki et al analyzed self-reported questionnaires among 378 Japanese patients with non-valvular AF (77% warfarin users) and found that 86% of patients were adherent to anticoagulation therapy. They hypothesized that the high adherence rate was owing to patient characteristics of long-standing history of AF and comorbid heart failure; however, it is unclear whether this may hold true for the cohort in our study.…”

Section: Discussionsupporting

confidence: 87%

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Adherence and Concomitant Medication Use among Patients on Warfarin Therapy: Insight from a Large Pharmacy Dispensing Database in Japan

Takeuchi

Nakano

Tanaka‐Mizuno

et al. 2019

Biological & Pharmaceutical Bulletin

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Warfarin is a drug used for anticoagulation management, with a narrow therapeutic range and multiple drug-drug interactions. Adherence and proper use of concomitant medication are thus fundamental to the efficacy and safety of warfarin therapy. In 2012, we retrospectively analyzed data from three large-scale pharmacy chains in Japan. We included all adults (≥ 20 years old) with at least one record of warfarin dispensation. We examined patient demographic data, adherence as measured by medication possession ratio (MPR), and co-dispensation focusing on the number of concomitant dispensations and concurrent use of medications that increase bleeding risk. Thresholds of underadherence and overadherence were set at <0.9 and >1.1, considering the narrow therapeutic window. We reviewed 443007 warfarin dispensation records of 71340 individuals (median age, 73 years; 62% male). The MPR was 1.0 (interquartile range: 0.96-1.0), and underadherence and overadherence was found in 16.3 and 1.9% of individuals, respectively. The median number of co-dispensed drugs was eight at each pharmacy encounter, which did not differ by age group. Drugs associated with a high bleeding risk were dispensed in 40.0% of encounters and accounted for 16.4% of all co-dispensed drugs. In summary, we found optimal overall adherence, as assessed by MPR, among our Japanese study population, even when defining a strict cutoff value. However, polypharmacy was common in all age groups and medications with a high bleeding risk profile were often co-dispensed with warfarin. Future research addressing how these dispensation patterns affect patient outcome is warranted.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 87%

Adherence and Concomitant Medication Use among Patients on Warfarin Therapy: Insight from a Large Pharmacy Dispensing Database in Japan

Takeuchi

Nakano

Tanaka‐Mizuno

et al. 2019

Biological & Pharmaceutical Bulletin

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“…Treatment persistence with rivaroxaban will also be revealed in the XAPASS. Treatment persistence is a major concern in stroke prevention because discontinuation of anticoagulation therapy affects the stroke risk in patients with AF . Persistence with rivaroxaban in the XANTUS was 80% at 1 year .…”

Section: Discussionmentioning

confidence: 99%

“…Treatment persistence is a major concern in stroke prevention because discontinuation of anticoagulation therapy affects the stroke risk in patients with AF. 16 Persistence with rivaroxaban in the XANTUS was 80% at 1 year. 11 This is higher than in recent US studies 17,18 under the supervision of a steering committee.…”

Section: Age and Body Weightmentioning

confidence: 99%

Design and baseline characteristics of the Xarelto Post‐Authorization Safety & Effectiveness Study in Japanese Patients with Atrial Fibrillation (XAPASS)

Ogawa

Minematsu

Ikeda

et al. 2018

Journal of Arrhythmia

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BackgroundThe phase III Japanese Rivaroxaban Once‐Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (J‐ROCKET AF) showed that the rivaroxaban group had a lower event rate of intracranial bleeding than the warfarin group and that rivaroxaban was noninferior to warfarin for the principal safety outcome. However, safety and effectiveness data from unselected patients with AF in everyday clinical practice in Japan are lacking.MethodsThe Xarelto Post‐Authorization Safety & Effectiveness Study in Japanese Patients with Atrial Fibrillation (XAPASS) is a real‐world, prospective, single‐arm, observational study mandated by the Japanese authority as postmarketing surveillance. XAPASS involves patients with nonvalvular AF prescribed rivaroxaban. The principal safety outcome is a composite of major and nonmajor bleeding events, and the primary effectiveness outcome is the incidence of ischemic stroke, hemorrhagic stroke, noncentral nervous system systemic embolism, and myocardial infarction.ResultsIn total, 11 308 patients were enrolled from April 2012 to June 2014. Their age was 73.1 ± 9.9 years, and their CHADS 2 score was 2.2 ± 1.3. Female patients, patients aged ≥75 years, patients with a body weight of ≤50 kg, and patients with a creatinine clearance of <50 mL/min constituted 38.1%, 48.7%, 19.5%, and 23.9% of all patients, respectively. Almost half (53.2%) of patients were prescribed other anticoagulants before starting rivaroxaban.ConclusionsData from this study will supplement those from the J‐ROCKET AF and provide practical information for the optimal use of rivaroxaban for stroke prevention in Japanese patients with AF (Clinicaltrials.gov: NCT01582737).

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“…Dosing frequency with once-daily dosing relative to more frequent (two to four times) daily dosing regimens facilitates adherence for chronic cardiovascular drugs, as well as antihypertensive drugs. Once-daily dosing of ASM monotherapy would likely improve adherence [18][19][20].…”

Section: Plos Onementioning

confidence: 99%

Forgetting to take antiseizure medications is associated with focal to bilateral tonic-clonic seizures, as revealed by a cross-sectional study

et al. 2020

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Objectives To evaluate the effects of nonadherence to antiseizure medications (ASMs) and clinical characteristics on seizure control, we employed a prospective cohort cross-sectional study using self-reports and medical records of patients with epilepsy (PWEs). Methods Eight hundred and fifty-five PWEs taking ASMs were enrolled from fourteen collaborative outpatient clinics from January 2018 to March 2019. Questions from the Morisky Medication Adherence Scale were used as adherence self-reports. If a PWE's questionnaire indicated that they had missed doses of their ASMs, outpatient physicians asked them directly about the details of their compliance, including the timing of intentionally or unintentionally missed doses. The association between lack of seizure control and utilization outcomes, such as missed doses, demographics, and clinical characteristics of the PWEs, were assessed by univariate and multivariate analyses. Results Multivariate analysis revealed that forgetting to take ASMs was associated with lack of seizure control and the existence of focal to bilateral tonic-clonic seizures. Dementia, younger age, use of three or more antiepileptic agents, and living in a one-person household were associated with the risk of forgetting to take ASMs. Significance For PWEs with poor drug management or a high incidence of missed doses of ASMs, efforts to improve adherence could facilitate better seizure control and decrease focal to bilateral tonic-clonic propagation.

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Adherence to medication and characteristics of Japanese patients with non-valvular atrial fibrillation

Abstract: Our study showed that the prevalence of non-adherence to medications was 14% in NVAF patients. Frequent daily dosing was an independent risk factor for non-adherence to medication (UMIN-CTR No. UMIN 000023514).

Cited by 27 publications

References 39 publications

Adherence and Concomitant Medication Use among Patients on Warfarin Therapy: Insight from a Large Pharmacy Dispensing Database in Japan

Adherence and Concomitant Medication Use among Patients on Warfarin Therapy: Insight from a Large Pharmacy Dispensing Database in Japan

Design and baseline characteristics of the Xarelto Post‐Authorization Safety & Effectiveness Study in Japanese Patients with Atrial Fibrillation (XAPASS)

Forgetting to take antiseizure medications is associated with focal to bilateral tonic-clonic seizures, as revealed by a cross-sectional study

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