Comparisons of effectiveness and safety between on-label dosing, off-label underdosing, and off-label overdosing in Asian and non-Asian atrial fibrillation patients treated with rivaroxaban: a systematic review and meta-analysis of observational studies.
Europace
; 25(10)2023 10 05.
Article
en En
| MEDLINE
| ID: mdl-37738425
ABSTRACT
AIMS:
Limited real-world data show that rivaroxaban following dosage criteria from either ROCKET AF [20â mg/day or 15â mg/day if creatinine clearance (CrCl) < 50â mL/min] or J-ROCKET AF (15â mg/day or 10â mg/day if CrCl < 50â mL/min) is associated with comparable risks of thromboembolism and bleeding with each other in patients with non-valvular atrial fibrillation (NVAF). We are aimed to study whether these observations differ between Asian and non-Asian subjects. METHODS ANDRESULTS:
A systematic review and meta-analysis with random effects was conducted to estimate the aggregate hazard ratio (HR) and 95% confidence interval (CI) using PubMed and MEDLINE databases from 8 September 2011 to 31 December 2022 searched for adjusted observational studies that reported relevant clinical outcomes of NVAF patients receiving rivaroxaban 10â mg/day if CrCl > 50â mL/min, on-label dose rivaroxaban eligible for ROCKET AF or J-ROCKET AF, and rivaroxaban 20â mg/day if CrCl < 50â mL/min. Effectiveness and safety endpoints were compared between ROCKET AF and J-ROCKET AF dosing regimen in Asian and non-Asian subjects, separately. Also, risks of events of rivaroxaban 10â mg/day despite of CrCl > 50â mL/min and rivaroxaban 20â mg/day despite of CrCl < 50â mL/min were compared to that of 'ROCKET AF/J-ROCKET AF dosing'. Sensitivity analyses were performed by sequential elimination of each study from the pool. The meta-regression analysis was performed to explore the influence of potential factors on the effectiveness and safety outcomes. Eighteen studies involving 67 571 Asian and 54 882 non-Asian patients were included. Rivaroxaban following J-ROCKET AF criteria was associated with comparable risks of thromboembolism in the Asian subgroup, whereas rivaroxaban following J-ROCKET AF criteria was associated with higher risks of all-cause mortality (HR1.30; 95% CI1.05-1.60) compared with that of ROCKET AF criteria in the non-Asian population. There were no differences in risks of major bleeding between rivaroxaban following J-ROCKET AF vs. ROCKET AF criteria either in the Asian or non-Asian population. The use of rivaroxaban 10â mg despite of CrCl > 50â mL/min was associated with a higher risk of thromboembolism (HR1.64; 95% CI1.28-2.11) but lower risk of major bleeding (HR0.72; 95% CI0.57-0.90) compared with eligible dosage criteria. The use of rivaroxaban 20â mg despite of CrCl < 50â mL/min was associated with worse clinical outcomes in the risks of thromboembolism (HR1.32; 95% CI1.09-1.59), mortality (HR1.33; 95% CI1.10-1.59), and major bleeding (HR1.26; 95% CI1.03-1.53) compared with eligible dosage criteria. The pooled results were generally in line with the primary effectiveness and safety outcomes by removing a single study at one time. Meta-regression analyses failed to detect the bias in most potential patient characteristics associated with the clinical outcomes.CONCLUSION:
Rivaroxaban dosing regimen following J-ROCKET criteria may serve as an alternative to ROCKET AF criteria for the Asian population with NVAF, whereas the dosing regimen following ROCKET AF criteria was more favourable for the non-Asian population. The use of rivaroxaban 10â mg despite of CrCl > 50â mL/min was associated with a higher risk of thromboembolism but a lower risk of major bleeding, while use of rivaroxaban 20â mg despite of CrCl < 50â mL/min was associated with worse outcome in most clinical events.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
/
Tromboembolia
/
Accidente Cerebrovascular
Tipo de estudio:
Observational_studies
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Europace
Asunto de la revista:
CARDIOLOGIA
/
FISIOLOGIA
Año:
2023
Tipo del documento:
Article
País de afiliación:
Taiwán