Oral anticoagulants still underutilized in atrial fibrillation: study

The introduction of direct oral anticoagulants, such as J&J and Bayer's Xarelto, has only moderately increased the number of atrial fibrillation patients receiving any oral anticoagulant, a study found.

Drugmakers have turned new generation anticoagulants into blockbusters as treatments for strokes and heart attacks, but one area of care where they have made little progress is for treating atrial fibrillation patients. Cardiology professionals in a new study say that is unfortunate for patients.

Published in the Journal of the American College of Cardiology, the study found the number of eligible atrial fibrillation patients taking oral anticoagulants to prevent a stroke grew to 61%—from 52%—between 2008 and 2014. Over the period, the FDA approved Boehringer Ingelheim’s Pradaxa, Johnson & Johnson and Bayer’s Xarelto and Pfizer and Bristol-Myers Squibb’s Eliquis.

Summarizing the findings, JACC editor-in-chief Dr. Valentin Fuster called the increase “close to trivial.” Warfarin use among the patients decreased to 35%—from 52%—over the period, while use of the new anticoagulants grew to 26%—from 0%.

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For the work, the authors identified 655,000 patients with nonvalvular AF at risk of having a stroke in a national registry between April 1, 2008, and September 30, 2014. After running the numbers, they noted a large variation of overall oral anticoagulant use between practices, ranging from 11% use at the low end to 79% on the high end. It’s a finding Fuster called “amazing.”

“With the use of the new oral anticoagulants, everybody got excited and thought that the problem was going to be solved,” Fuster said of oral anticoagulant underutilization for the patients.

“This has not been the case,” he continued.

In a related journal editorial, authors Sean Pokorney, Eric Peterson and Jonathan Piccini called for a “combined and united” effort in the profession to “find ways of bridging the gap” and improving patient care.

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This represents a market opportunity for drugmakers which have had significant success with their drugs. 

Since introducing their new oral anticoagulants, drugmakers in the class have been wrangling for the market share lead, with BMS reporting last month that third-to-market Eliquis had finally snagged the crown from its rivals.

Xarelto was Bayer’s top-selling med last year at $3.24 billion and ranked third for J&J, with $2.5 billion in sales. BMS reported $3.34 billion in Eliquis sales last year. BI generated $1.55 billion in Pradaxa sales in 2016.

But the study also comes as the companies fend off lawsuits alleging their medications caused serious injury or death due to bleeding. J&J recently reported that it’s facing 18,400 liability cases with Xarelto. BMS is facing more than 130 cases with Eliquis.