28 Jun Comparative effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with venous thromboembolism: a cohort study
Although several studies have compared the effectiveness and safety of rivaroxaban and apixaban in patients with venous thromboembolism (VTE), direct comparison of these drugs with edoxaban is lacking.
We compared the effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with VTE.
In this retrospective cohort study using a Japanese hospital administrative database, we identified three mutually exclusive groups of patients with VTE beginning treatment with edoxaban, rivaroxaban, or apixaban. Primary effectiveness outcome was recurrent VTE, and principal safety outcome was a composite of intracranial hemorrhage and gastrointestinal bleeding. Subjects were followed for up to 180 days. Baseline characteristics among groups were balanced using propensity score matching weights.
3,369 edoxaban, 1,592 rivaroxaban, and 1,998 apixaban initiators were identified. There were no significant differences among the three drugs in the prevention of recurrent VTE (adjusted incidence rate ratio [aIRR], 0.77; 95% confidence interval [CI], 0.45 to 1.30 for edoxaban vs rivaroxaban; aIRR, 0.92; 95% CI, 0.54 to 1.56 for edoxaban vs apixaban; and aIRR, 1.20; 95% CI, 0.69 to 2.10 for rivaroxaban vs apixaban), or in the risk of intracranial hemorrhage or gastrointestinal bleeding (aIRR, 1.57; 95% CI, 0.85 to 2.90 for edoxaban vs rivaroxaban; aIRR, 1.30; 95% CI, 0.76 to 2.23 for edoxaban vs apixaban; and aIRR, 0.83; 95% CI, 0.42 to 1.64 for rivaroxaban vs apixaban).
In routine care, edoxaban, rivaroxaban, and apixaban appear to have similar effectiveness and safety in the treatment of VTE.