Meta-Analysis for All-Cause Death for Apixaban vs. Placebo or Control in SPAF Trials

• Activity Number: 547
• Type: Contributed
• Date/Time: Wednesday, August 7, 2013 : 10:30 AM to 12:20 PM
• Sponsor: Biopharmaceutical Section
• Author(s): Li Wang*+ and Weihua Tang
• Companies: Bristol Myers Squibb and Bristol Myers Squibb
• Keywords: meta analysis ; indirect comparison ; Apixaban ; DerSimonian and Laird

Abstract

In the ARISTOTLE trial, apixaban was superior compared with warfarin for reduction of all-cause death. In the AVERROES trial, which was stopped early due to superior efficacy finding of substantial treatment benefit of apixaban to reduce stroke and systemic embolism vs asparin, apixaban reduced incidence of all-cause death compared to asparin although this was not statistically significant. It would be of interest to assess the effect of apixaban vs. placebo or control (other than asparin or warfarin) in terms of reducing all-cause death in SPAF trials. Since no direct comparison data between apixaban and placebo or control is available, indirect comparisons between apixaban and placebo or control were first done using ARISTOTLE and AVERROES trials data and Hart.et al 2007 meta analysis data, where warfarin and asparin vs placebo or control data are available . A meta analysis with the fixed DerSimonian and Laird model was then used to combine the results from two indirect comparisons to explore the effect of apixaban vs. placebo or control. Heterogeneity was not significant and apixaban significantly reduced all-cause death compared to placebo or control.