medication adherence to rivaroxaban and dabigatran in patients with non-valvular atrial fibrillation: a meta-analysis

Several real-world studies have evaluated adherence to direct acting oral anticoagulants in patients with non-valvular atrial fibrillation (nvaf); however, these studies have not been systematically summarized. we performed a meta-analysis to compare adherence to rivaroxaban versus dabigatran therapy in united states (us) patients with nvaf in a real-world setting. medline and scopus were searched from 2010 to 2018 using keywords and mesh terms related to adherence and oral anticoagulants. we included real-world studies of us adults with nvaf comparing adherence to dabigatran and rivaroxaban. studies evaluating adherence by a measure other than proportion of days covered (pdc) were excluded. the proportion of patients with a pdc ≥ 80 (a commonly utilized definition of adherence) served as the primary outcome of interest. we conducted meta-analysis of non-overlapping studies using the hartung–knapp random-effects model to estimate risk ratios (rrs) with corresponding 95% confidence intervals (cis). we included 5 studies evaluating 80,230 patients (range 2667–22,571). median follow-up across studies was 6 months (range 3–12 months). the proportion of patients with a pdc ≥ 80 ranged from 59.5 to 83.5% for rivaroxaban users and 57.3 to 78.3% for dabigatran users. upon meta-analysis, rivaroxaban use was associated with increased adherence compared with dabigatran use (rr  1.08; 95% ci  1.03–1.12; i2 = 88%). in conclusion, rivaroxaban was associated with increased adherence when compared to dabigatran in ~ 80,000 patients in a real-world setting. possible explanations for this include dosing frequency or patient tolerance.