(90) The Utilisation of Low-Dose Rivaroxaban in Patients with Atherosclerotic Cardiovascular Disease in The United Kingdom and The Netherlands

Friday, August 26, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 421

Presenting Author(s)

Nicholas B. Hunt
– University of Utrecht, Utrecht, Utrecht, Netherlands

Co-Author(s)

Allan Salih
– Uppsala University, Sweden
Marloes Bazelier, PhD
– Utrecht University, Netherlands
Björn Wettermark, MscPharm, PhD
– Professor, Uppsala university, Uppsala, Sweden
Sander van Doorn, PhD
– University Medical Centre Utrecht, Netherlands
Helga Gardarsdottir, PhD, FISPE
– Associate Professor, University of Utrecht, Utrecht, Netherlands
Olaf H. Klungel, PharmD, PhD, FISPE
– Professor of pharmacoepidemiology, University of Utrecht, Utrecht, Netherlands
Romin Pajouheshnia, PhD
– Assistant Professor (formerly), University of Utrecht, The Hague, Zuid-Holland, Netherlands

Background: Low-dose rivaroxaban has been indicated for the management of atherosclerotic cardiovascular disease (ASCVD), since recent (2019-20) updates to European and national prescribing guidelines. Here, we ascertain whether the guideline changes are reflected in real-world data from the UK and the Netherlands.

Objectives: i. To describe the trends of the utilisation of low-dose rivaroxaban over the period 1st January 2015 to 31st December 2020, in two European countries.
ii. To determine characteristics of patients who are prescribed low-dose rivaroxaban for the management of ASCVD.

Methods: In patients with a prior ASCVD diagnosis, utilisation of low-dose rivaroxaban (2.5mg, twice daily) was measured in CPRD Aurum (UK) and the PHARMO database network (Netherlands, NL), from 2015 to 2020. Monthly cross-sections were taken to calculate prevalence and incident prescribing (CPRD Aurum) and dispensing (PHARMO) of low-dose rivaroxaban. Incidence rates (IRs), incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated. IRRs compared utilisation in the years 2019 and 2020 to reference period 2015-2018, prior to the guideline changes. Comparisons between users or non-users were made using mean differences (MD) in demographic covariates and using chi-squared tests.

Results: We included 708,390 ASCVD patients from the UK and 415,380 from the Netherlands, with a median follow-up time of 1043 and 1856 days respectively. In the UK, the IR of new use of low-dose rivaroxaban in the period 2015-2018 was 13.24 per 100,000 person-years, in 2019 the IR was 41.89 (IRR 3.16, 95% CI [2.55;3.91]) and in 2020, 117.16 (IRR 8.85, 95% CI [7.46;10.50]). While in the Netherlands, the IR in 2015-2018 was 2.04 per 100,000 person-years, in 2019 the IR was 37.30 (IRR 18.26, 95% CI [12.10;27.55]) and in 2020, 20.91 (IRR 10.24, 95% CI [6.41;16.36]). Low-dose rivaroxaban users were younger at the start of follow-up (UK MD 6.50 years; NL MD 2.31 years, both p< 0.05) and more likely male (UK 74.3% versus 62.9% in non-users; NL 76.8% versus 58.6%, both p< 0.001).

Conclusions: European and national prescribing guideline changes were associated with a vast increase in use of low-dose rivaroxaban among patients with ASCVD in the UK and in the Netherlands. The utilisation should continue to be recorded to find the extent of the uptake of the recommendations.