Assessment of an Education and Guidance Programme for Eliquis Adherence in Non-Valvular Atrial Fibrillation (AEGEAN)

Phase 4

Completed

Conditions: Non-valvular Atrial Fibrillation

Interventions: Drug: Apixaban

Registration Number: NCT01884350

Lead Sponsor: Bristol-Myers Squibb

Brief Summary: The study purpose is to assess the impact of an educational program on patient adherence in patients taking Apixaban for SPAF at 24 weeks

Detailed Description: SPAF=Stroke Prevention in Atrial Fibrillation

ISTH=International Society on Thrombosis and Hemostasis

Primary Purpose: Other: To measure adherence to the study medication using an electronic monitoring device over the first 24 weeks on study medication

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 1217

Inclusion Criteria

Patients with diagnosed non-valvular Atrial Fibrillation (AF) or atrial flutter (documented by 12-lead electrocardiogram (ECG) or Holter recording) and eligible for oral anticoagulant (OAC) therapy
Presence of at least one of the following risk factors for stroke:

Prior stroke or transient ischaemic attack (TIA)
- Age ≥75 years
- Hypertension
- Diabetes mellitus
- Symptomatic heart failure [New York Heart Association (NYHA) Class ≥II]
Must be able to self-administer treatment
Either Vitamin K antagonists (VKA) treated or VKA naive. Patients treated with VKA should have received the VKA treatment for ≥3 months. VKA naïve patients should not have received VKA treatment for more than 30 days within the last 12 months. Patients who are not described by either of the above criteria are not eligible for the study
Patients previously treated with acetylsalicylic acid (ASA) for stroke prevention are allowed (and will switch to Apixaban)
Patients with screening mini-mental state examination (MMSE) more than 24
Subject Re-enrollment: This study does not permit the re-enrollment of a subject that has discontinued the study as a pre-treatment failure

Age and Reproductive Status:

i) Men and women ≥18 years of age
ii) Women of childbearing potential (WOCBP) must use method(s) of contraception based on the tables in protocol. WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to the start of study medication
iv) Women must not be breastfeeding
v) Men who are sexually active with women of childbearing potential (WOCBP) must use any contraceptive method with a failure rate of less than 1% per year
vi) Women who are not of childbearing potential (ie, who are postmenopausal or surgically sterile); and azoospermic men do not require contraception

Exclusion Criteria

Target Disease Exceptions:
1. Atrial fibrillation or flutter due to reversible causes (e.g. thyrotoxicosis, pericarditis)
2. Clinically significant (moderate or severe) mitral stenosis
3. Cardiac valvular disease requiring surgery
4. Planned major surgery or/and invasive procedure and/or atrial fibrillation or flutter, ablation procedure and/or cardioversion
5. Patients receiving Rivaroxaban, Dabigatran or Apixaban
Medical History and Concurrent Diseases:
1. Conditions other than atrial fibrillation that require chronic anticoagulation (e.g., prosthetic mechanical heart valve, venous thromboembolism; also see Section 3.4, Concomitant Treatments)
2. Patient with serious bleeding in the last 6 months or with a lesion or condition at high risk of bleeding such as:
  - Active peptic ulcer disease, current or recent gastrointestinal ulceration
  - Known or suspected esophageal varices
  - Recent ischemic stroke (within 7 days)
  - Recent brain or spinal injury or intracranial hemorrhage
  - Recent brain, spinal or ophthalmic surgery
  - Arteriovenous malformations
  - Vascular aneurysms
  - Major intraspinal or intracerebral vascular abnormalities
  - Documented hemorrhagic tendencies or blood dyscrasias
  - Presence of malignant neoplasms at high risk of bleeding

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 1: Apixaban (Primary SOC information)	Apixaban	Apixaban 2.5 mg or 5 mg by mouth twice daily for 48 weeks and Primary Standard of Care (SOC) information
Arm 2: Apixaban (Additional Educational Program)	Apixaban	Apixaban 2.5 mg or 5 mg by mouth twice daily for 48 weeks and Additional Educational Program

Primary Outcome Measures

Name	Time	Method
Percentage of Days With a Correct Execution of the Apixaban Dosing Regimen	Day 1 up to week 24	The mean percentage of days which participants maintained adherence to apixaban treatment was measured for each arm. Adherence to apixaban = number of units of adherence \*100 / total number of eligible days for the time period from first dose date, up to 169 days. Unit of adherence: A 24-hour window where the treatment is taken as prescribed, ie, 1 tablet (5 mg or 2.5 mg, as appropriate) 2 times a day. If only one dose is missed in 24-hours, it is still considered as a unit of adherence. Adherence up to 24 weeks was calculated as the percentage of adherence units within that period. If a participant discontinued from the study before 24 weeks, the denominator time period was censored at the earlier of last dose date or discontinuation date for discontinuation due to reasons unrelated to participant adherence, such as withdrawn consent, or AE; otherwise, the period was censored at the minimum of 169 days and last dose date + 30 days.

Secondary Outcome Measures

Name	Time	Method
Percentage of Days With a Correct Execution of the Apixaban Dosing Regimen During the 12 to 24 Weeks Period Compared With During the First 12 Weeks	Day 1 to Week 12, Week 12 to Week 24	The mean adherence to apixaban treatment during the first 24 weeks was measured between the standard of care (SOC) information and Additional Education Program (AEP) arms and expressed as a percentage. Adherence to Apixaban = number of units of adherence \*100 / total number of eligible days for the time period.
Percentage of Days With a Correct Execution of the Apixaban Dosing Regimen During the 24 to 48 Weeks Period	Week 24 to Week 48	The mean percentage of days which participants maintained adherence to apixaban treatment was measured for each arm. Adherence to apixaban = number of units of adherence \*100 / total number of eligible days for the time period from first dose date, up to 169 days. Unit of adherence: A 24-hour window where the treatment is taken as prescribed, ie, 1 tablet (5 mg or 2.5 mg, as appropriate) 2 times a day. If only one dose is missed in 24-hours, it is still considered as a unit of adherence. Adherence over 24 weeks was calculated as the percentage of adherence units within that period. If a participant discontinued from the study before 48 weeks, the denominator time period was censored at the earlier of last dose date or discontinuation date for discontinuation due to reasons unrelated to participant adherence, such as withdrawn consent, or AE; otherwise, the period was censored at the minimum of 169 days and last dose date + 30 days.
Non-adherence Predictors of 20% or More (vs. at Least 80% Adherence) at 24 Weeks	Week 24	Logit analyses were conducted on the Primary Efficacy Set to identify non-adherence predictors of 20% or more (vs. at least 80% adherence) at 24 weeks. In the Primary SOC group, alcohol use, Mini-Mental State Evaluation (MMSE) score, UK standard occupational classification, and type of atrial fibrillation were retained in the model (p-value \<= 0.2). In the Additional Educational Program group, alcohol use, type of atrial fibrillation, age and Vitamin K Antagonists (VKA) status were retained in the model (p-value \<= 0.2). Odds ratios are presented for predictors of non-adherence.
Number of Participants With Serious Adverse Events (SAEs), Drug Related Adverse Events (AE), AE Leading to Discontinuation, and Death	Week 24 up to Week 48	Adverse events with onset date after 24 weeks are included in this summary. AE=any new unfavorable symptom, sign, or disease or worsening of a preexisting condition that may not have a causal relationship with treatment. SAE=a medical event that at any dose results in death, persistent or significant disability/incapacity, or drug dependency/abuse; is life-threatening, an important medical event, or a congenital anomaly/birth defect; or requires or prolongs hospitalization. Treatment-related=having certain, probable, possible, or missing relationship to study drug.