Comparison of Real-World Adherence and Persistence of Prasugrel and Clopidogrel TherapyAuthors: Scott Charland1, Nathan Markward1, Eric Stanek1 Background: Nonadherence or non-persistence to prasugrel (P) or clopidogrel (C) therapy may negatively impact clinical outcomes. However, no comparative information is available for these agents. Methods: A retrospective cohort analysis was conducted using a de-identified pharmacy benefits database. Subjects with a new P or C prescription claim (no P or C claims ≤4 months prior) between 7/1 to 9/30/2009, continuous eligibility for an additional 12 months, and ≥1 P or C refill over follow-up (365 days) were included. Adherence to therapy over 12 months was determined by medication possession ratio (MPR). Persistence over 12 months was measured using a refill gap in therapy of ≥45 days. Results: The study included 75,092 patients receiving P (n=335) or C (n=74,757). Patients receiving P were younger [mean age 61±10 years (30% >65 y.o.) vs. C 69 ± 12 years (63% >65 y.o.); (p <0.001)] and more often male (72% vs. C 58%; p<0.001). Adherence was highly skewed, with MPR >0.9 in 48% of patients on P or C, and a similar proportion were defined as adherent (MPR>0.8) to P and C, at 64% and 60%, respectively. There were no significant differences in mean/median MPR between P (0.77±0.27/0.88) and C (0.77±0.26/0.88; Figure A). Persistence on therapy was also similar (P 64%; C 60%, Figure B). Conclusions: While the majority of patients have high adherence (MPR > 80%) to either prasugrel or clopidogrel , there remains significant opportunity to improve adherence and persistence in approximately 40% of patients receiving these drugs. 1 Medco Research Institute, Bethesda, MD |