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Real-World Utilization and Comparative Effectiveness of Treatment Options for Cancer–Associated Venous Thromboembolism
In the real-world setting, patients with cancer–associated venous thromboembolism (VTE) remain on anticoagulation for a short period of time and direct oral anticoagulants (DOACs) and warfarin may be associated with better compliance than low molecular weight heparin, according to an analysis presented at the 2022 ASCO Annual Meeting.
The analysis, presented by Irbaz Bin Riaz, Mayo Clinic, Phoenix, AZ, aimed to explore the real-world utilization and comparative effectiveness of direct oral anticoagulants, warfarin, and low molecular weight heparin among patients with cancer-associated VTE.
Data from a deidentified administrative claims database were used to assess utilization patterns, recurrent VTE, and major bleeding differences between the 3 treatment options.
Multinominal logistic regression assessed predictors of anticoagulant administration and Kaplan-Meier curves evaluated differences in time to medication discontinuation. Propensity score and inverse probability of treatment weighting balanced baseline differences. Cox proportional hazards regression was used to assess outcomes in propensity score weighted groups.
A total of 5100 patients were identified and included in the analysis. Of these patients, 49.3% filled DOACs (n = 2512), 29.2% filled low molecular weight heparin (n = 1488), and 28.6% filled warfarin (n = 1460). The median treatment duration was 3.2 months for DOACs and warfarin and 1.8 months for low molecular weight heparin (P <.01).
Findings from multinominal regression analysis showed that younger patients were more likely to be prescribed low molecular weight heparin (odd ratio [OR], 0.97; 95% CI, 0.97 to 0.98) vs DOACs. In addition, patients with lung (OR, 2.07; 95% CI, 1.12 to 3.65; OR, 1.87; 95% CI, 1.04 to 3.37), urological (OR, 1.94; 95% CI, 1.08 to 3.49; OR, 2.04; 95% CI, 1.12 to 3.73), gynecological (OR, 4.25; 95% CI, 2.31 to 7.82; OR, 2.31; 95% CI, 1.22 to 4.39) and colorectal cancer (OR, 2.26; 95% CI, 1.20 to 4.32; OR, 2.51; 95% CI, 1.32 to 4.79) were more likely to be prescribed low molecular weight heparin or warfarin respectively, compared to DOACs.
Recurrent VTE was more frequent among patients received low molecular weight heparin (hazard ratio [HR], 1.47; 95% CI, 1.14 to 1.90) or warfarin (HR, 1.46; 95% CI, 1.13 to 1.87) compared to DOACs.
Greater rates of major bleeding were reported with low molecular weight heparin, but not warfarin, compared to DOACs (HR, 2.27; 95% CI, 1.62 to 3.20) as well as rates of all-cause mortality (HR, 1.61; 95% CI, 1.15 to 2.25).
Source:
Riaz IB, Bayne HEF, Deng Y, et al. Real-world utilization and comparative effectiveness of treatment options in cancer-associated thrombosis: A propensity score weighed analysis. Presented at: the 2022 ASCO Annual Meeting; June 3-7, 2022; Chicago, IL. Abstract 6589.
