Adherence and persistence analysis in patients treated with DAPT

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.