BACKGROUND: Low-dose rivaroxaban has been indicated for the man-agement of atherosclerotic cardiovascular disease (ASCVD), sincerecent (2019–20) updates to European and national prescribing guidelines. Here, we ascertain whether the guideline changes arereflected in real-world data from the UK and the Netherlands.
OBJECTIVES: i. To describe the trends of the utilization of low-dose riv-aroxaban over the period first January 2015 to 3first December 2020,in two European countries. ii. To determine characteristics of patientswho are prescribed low-dose rivaroxaban for the management ofASCVD.
METHODS: In patients with a prior ASCVD diagnosis, utilization of low-dose rivaroxaban (2.5mg, twice daily) was measured in CPRD Aurum(UK) and the PHARMO database network (Netherlands, NL), from2015 to 2020. Monthly cross-sections were taken to calculate preva-lence and incident prescribing (CPRD Aurum) and dispensing(PHARMO) of low-dose rivaroxaban. Incidence rates (IRs), incidencerate ratios (IRR) and 95% confidence intervals (CI) were calculated.IRRs compared utilization in the years 2019 and 2020 to referenceperiod 2015–2018, prior to the guideline changes. Comparisonsbetween 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 and415 380 from the Netherlands, with a median follow-up time of1043 and 1856 days respectively. In the UK, the IR of new use oflow-dose rivaroxaban in the period 2015–2018 was 13.24 per100 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 per100 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 morelikely male (UK 74.3% versus 62.9% in non-users; NL 76.8% versus58.6%, both p < 0.001).
CONCLUSIONS: European and national prescribing guideline changeswere associated with a vast increase in use of low-dose rivaroxabanamong patients with ASCVD in the UK and in the Netherlands. Theutilization should continue to be recorded to find the extent of theuptake of the recommendations.
