New real world study data on reduced risk of adverse kidney outcomes for Xarelto™ compared to VKA
Not intended for U.S. and UK Media - Data presented at American College of Cardiology (ACC.23)
In the prospective observational XARENO study, after a two year follow up period, Xarelto was associated with a reduced risk of adverse kidney outcomes and all-cause mortality in patients with non-valvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD), compared to vitamin K antagonists (VKA) / XARENO evaluated the impact of Xarelto in patients with NVAF and CKD, given that VKAs are associated with worsening of renal function compared to non-vitamin K antagonist oral anticoagulants (NOACs)
Berlin, March 6, 2023 – In the XARENO study, Xarelto (rivaroxaban) was associated with a reduced risk of adverse kidney outcomes in patients with non-valvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD) compared to vitamin K antagonists. All-cause mortality was also reduced; no differences were observed between groups for the composite net-clinical benefit. The final data from this study were presented at the American Congress of Cardiology’s 72nd Annual Scientific Session together with World Congress of Cardiology (ACC.23/WCC). First data from XARENO that revealed the association of Xarelto with a potential reduced risk of adverse kidney outcomes compared to VKA were presented a year ago at ACC.22.
“Previous trials evaluating NOACs vs VKAs for stroke prevention in non-valvular atrial fibrillation have excluded patients with advanced chronic kidney disease. Therefore, the clinical impact of NOACs versus VKAs in this patient population was unknown. The XARENO study results provide important evidence that can help physicians in the management of patients with atrial fibrillation and chronic kidney disease and help reduce patients’ risk of progressing to kidney failure,” said Reinhold Kreutz, Professor of Clinical Pharmacology, Charité - Universitätsmedizin Berlin, Germany.
XARENO is the first prospective observational study to evaluate the effectiveness and safety of a NOAC versus VKAs in treating patients with NVAF and advanced CKD (estimated glomerular filtration rates (eGFR) of 15-49 mL/min/1.73 m2). Avoiding worsening renal function is an important clinical consideration beyond stroke prevention when it comes to the selection of an oral anticoagulant in patients with NVAF. The XARENO study was undertaken to investigate the real-world effectiveness and safety of Xarelto compared with VKAs in this vulnerable patient group with NVAF and advanced CKD.
The study adds to the evidence obtained in the randomized controlled ROCKET-AF study and supports the use of Xarelto in this patient group, including the cautious use for patients with CKD stage 4 (the use of Xarelto is not recommended in patients with creatinine clearance < 15 ml/min). Consistent with previous data indicating various benefits of rivaroxaban over VKAs on kidney outcomes, XARENO also revealed that Xarelto was associated with a reduced risk of progression to CKD stage 5 or the initiation of chronic kidney replacement therapy. With XARENO and previous studies like ANTENNA Xarelto is the only NOAC that provides such broad evidence on the reduction of adverse kidney outcomes compared to VKA.
The XA inhibition in RENal patients with non-valvular atrial fibrillation Observational registry (XARENO) was an investigator initiated prospective, non-interventional, international multicenter study recruiting NVAF patients with CKD in five European countries.
Patients treated with Xarelto or VKA having estimated glomerular filtration rates (eGFR) between 15 and 49 mL/min per 1.73 m2 were eligible for inclusion. The study population comprised 764 patients in the Xarelto group and 691 in the VKA group. Patients without anticoagulation at the discretion of the attending physicians were also enrolled for explorative analysis. Pre-specified follow-up was at least 12 months with a planned extended data collection period for one up to two additional years. Propensity score overlap-weighted Cox regression was used to compare the Xarelto and VKA groups.
After a median of 2.1 years follow up, the study found that adverse kidney outcomes occurred 8.3 times per 100 patient years in the Xarelto group compared to 12.7 times in the VKA group (95% confidence interval [CI] 0.43 to 0.88, HR=0.62.) Adverse kidney outcome was defined as a composite of eGFR decline below 15 mL/min per 1.73 m2, need for chronic kidney replacement therapy or acute kidney injury.
The frequency of net-clinical benefit events - a composite of stroke or systemic embolism, major bleeding, myocardial infarction, acute coronary syndrome, or cardiovascular death - was 13.8 per 100 patient years in the rivaroxaban and 13.6 in the VKA group (95% CI 0.72 to 1.31, HR=0.97). The mortality rate (all-cause death) was 17.6 per 100 patient years in the rivaroxaban group and 21.9 in the VKA group (95% CI 0.59 to 0.98, HR=0.76).
About atrial fibrillation (AF) and chronic kidney disease (CKD)
AF is the most common sustained cardiac rhythm disorder. In AF, the upper chambers of the heart (atria) contract irregularly. As a result, blood does not flow properly, potentially allowing blood clots to form. These blood clots can break loose and travel to the brain, resulting in a stroke. Patients with AF can have a up to 5 times higher risk of stroke than those without AF. AF is frequently associated with comorbidities, including CKD.
It’s estimated that 15–20% of people with AF also have CKD. CKD is a common and potentially deadly condition that is widely underrecognized. The disease progresses silently and unpredictably, with many symptoms not appearing until CKD is well-advanced. CKD is one of the most frequent complications arising from diabetes and is also an independent risk factor of cardiovascular disease.
Previous studies have found that patients with both AF and renal impairment are at higher risk for bleeding and stroke. They are also more likely to be undertreated with oral anticoagulation than those with normal renal function.
About Rivaroxaban (Xarelto™)
Rivaroxaban is the most broadly indicated non-vitamin K antagonist oral anticoagulant (NOAC) worldwide and is marketed under the brand name Xarelto. Xarelto is approved for more venous and arterial thromboembolic (VAT) conditions than any other NOAC:
- The prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) with one or more risk factors
- The treatment of pulmonary embolism (PE) in adults
- The treatment of deep vein thrombosis (DVT) in adults
- The prevention of recurrent PE and/or DVT in adults
- The prevention of venous thromboembolism (VTE) in adult patients undergoing elective hip replacement surgery
- The prevention of VTE in adult patients undergoing elective knee replacement surgery
- The prevention of atherothrombotic events after an Acute Coronary Syndrome in adult patients with elevated cardiac biomarkers when co-administered with acetylsalicylic acid (ASA) alone or with ASA plus clopidogrel or ticlopidine
- The prevention of atherothrombotic events in adult patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk for ischemic events when co-administered with acetylsalicylic acid (ASA)
- Treatment of venous thromboembolism (VTE) and prevention of VTE recurrence in children and adolescents aged less than 18 years after at least 5 days of initial parenteral anticoagulation treatment
- Thromboprophylaxis (prevention of VTE and VTE related events) in children aged two years and older with congenital heart disease who have undergone the Fontan procedure
Xarelto is approved in more than 130 countries, although the approved labelling, including the number of indications may differ from country to country. Since launch in 2008, more than 114 million patients have been treated.
Rivaroxaban was discovered by Bayer and is being jointly developed with Janssen Research & Development, LLC. Xarelto is marketed outside the U.S. by Bayer and in the U.S. by Janssen Pharmaceuticals, Inc. (Janssen Research & Development, LLC and Janssen Pharmaceuticals, Inc. are part of the Janssen Pharmaceutical Companies of Johnson & Johnson).
Anticoagulant medicines are therapies used to prevent or treat serious illnesses and potentially life-threatening conditions. Before initiating treatment with anticoagulant medicines, physicians should carefully assess the benefit and risk for the individual patient.
Responsible use of Xarelto is a very high priority for Bayer, and the company has developed a Prescribers Guide for physicians and a Xarelto Patient Card for patients to support best practice.
To learn more about Xarelto, please visit www.xarelto.com
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