Real-world adherence and persistence of dual antiplatelet therapy over two years in patients with coronary artery diseases

Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA)/clopidogrel showed a statistically significant better persistence vs ASA/ticagrelor and ASA/prasugrel. However, no statistically significant differences were seen in adherence to ASA/clopidogrel fixed dose combination (FDC) vs the use of two different pills.

Main Takeaway

  • In this first study evaluating the difference in adherence between FDC vs each component taken as a separate pill, in patients with coronary artery disease treated with DAPT (at two years):
    • No statistically significant difference was found between FDC of ASA/clopidogrel and the combination of the two ASA and clopidogrel pills taken separately (P = 0.0752).
    • Adherence data were optimal for all types of DAPT analyzed (absolute value of adherence = 0.96).
  • In this real-life analysis, persistence to therapy was observed to be better in the ASA/clopidogrel group vs the ASA/prasugrel and the ASA/ticagrelor groups (at two years).
    • ASA/clopidogrel and ASA/clopidogrel (FDC) curves showed a statistically significant better persistence than ASA/prasugrel and ASA/ticagrelor curves (P <0.001).
    • However, the persistence data showed low adherence to the guidelines.

Why This Matters

  • There is a lack of consensus regarding the optimal duration of DAPT for patients with coronary artery disease.
  • Additionally, long-term adherence to DAPT remains a challenge in the management of patients with cardiovascular diseases in real-life, due to various factors like need for prolonged therapy, lack of proper prescription in the context of primary care, and the instructions provided at hospital discharge.
  • This real-world study therefore, evaluated adherence and persistence over two years in patients receiving DAPT.

Study Design

  • This non-interventional, retrospective study included all patients treated with DAPT in the Hospital of Pescara (Italy) utilizing data from the Hospital reimbursement database.
  • The study population consisted of prevalent users of clopidogrel, ASA, prasugrel, and ticagrelor (administered as first-line therapy).

Key Results

  • Overall, 519 patients treated with DAPT were included in the analysis (male = 83%; median age = 63; ASA/clopidogrel, n = 277; ASA/prasugrel, n = 77; ASA/ticagrelor, n = 57, and ASA/clopidogrel FDC, n = 108).
  • Persistence (at two years): Persistence to therapy was observed to be better in the ASA/clopidogrel group vs the ASA/prasugrel and the ASA/ticagrelor groups
    • ASA/clopidogrel and ASA/clopidogrel (FDC) curves showed a statistically significant better persistence than ASA/prasugrel and ASA/ticagrelor curves (P <0.001).
    • In total, 34 patients remained on ASA/clopidogrel and 18 patients remained on ASA/clopidogrel (FDC); while 1 patient each remained on ASA/prasugrel and ASA/ticagrelor therapies.
    • Overall persistence data showed low adherence to the guidelines.
  • Adherence (at two years): Adherence to therapy was optimal for all types of DAPT analyzed and remained stable over the study period
    • Absolute value of adherence at two years was 0.96 and adherence ≥ 0.8 was observed in 94% of the patients
    • ASA/prasugrel group had better adherence vs the other groups: Absolute value of adherence was 0.98; and adherence value ≥ 0.8 was seen in 97% of the patients
    • FDC ASA/clopidogrel group had poor adherence vs the other groups: Absolute value of adherence was 0.94; and adherence value ≥ 0.8 was seen in 88% of the patients
    • No statistically significant difference was found between FDC of ASA/clopidogrel and the combination of the two ASA and clopidogrel pills taken separately (P = 0.0752).

Limitations

  • The reasons for non-persistence of therapy were not evaluated as the analysis was based on data from an administrative database.

    Romagnoli A, Santoleri F, Costantini A. Adherence and persistence analysis in patients treated with double antiplatelet therapy (DAPT) at two years in real life. Patient Educ Couns. 2021:S0738-3991(21)00005–7. doi: 10.1016/j.pec.2021.01.005. Epub ahead of print. PMID: 33461875.

MAT-BH-2200186/v1/Mar 2022