joint replacementNICE has recommended a new treatment edoxaban (Lixiana) to help prevent stroke and systemic embolism (SE) in patients suffering from the heart rhythm disorder atrial fibrillation (AF). 

The NICE recommendation comes shortly after edoxaban received European marketing authorisation in June 2015 for two indications:

Prevention of stroke and SE in adult patients with NVAF with one or more risk factors, such as congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischaemic attack (TIA)  

  • Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults. The NICE final recommendation for this indication was obtained in August 2015.
The final NICE recommendation states: “Edoxaban is recommended, within its marketing authorisation, as an option for preventing stroke and systemic embolism in adults with non-valvular atrial fibrillation with one or more risk factors, including congestive heart failure, hypertension, diabetes, prior stroke or transient ischaemic attack, or age 75 years or older.” It adds: “The Committee concluded that taking all of the analyses into account, edoxaban was cost effective compared with warfarin and could be recommended as an alternative to warfarin for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation who have one or more risk factors for stroke.”

Edoxaban, made by the pharmaceutical company Daiichi Sankyo, is one of the class of blood-thinning drugs known as novel oral anticoagulants (NOACs). These drugs are used as an alternative to warfarin, which has been widely used for over 50 years but requires frequent monitoring to ensure the drug is working properly and is also associated with many food and drug interactions.

The final NICE recommendation noted: “The Committee accepted the limitations of warfarin therapy and the considerable impact it may have on people who take it, and recognised the potential benefits of edoxaban for people with non-valvular atrial fibrillation,” and concluded that, “edoxaban was as clinically effective as warfarin for the primary efficacy outcome of reducing stroke (ischaemic and haemorrhagic) and systemic embolism, and had nearly half the rate of haemorrhagic stroke events compared to warfarin.”

Professor Martin Cowie, Professor of Cardiology at Imperial College London and noted researcher of AF, said edoxaban gives doctors the ability to better tailor medicines to individual patients. “A few years ago, all we had to prevent strokes in AF patients was warfarin, which imposes many lifestyle restrictions on patients and needs monitoring with a blood test system measuring International Normalised Ratio (INR). Now we have choices with modern blood-thinning drugs that do not need INR monitoring and are easy for patients to live with.”

AF is the most common type of heart rhythm disorder, and is associated with substantial morbidity and mortality. According to NICE, the estimated prevalence of AF in England is 1.6% of adults aged 18 or over, which equates to approximately 835,000 cases. Of these 835,000 cases, between 476,000 and 702,000 adults could require anticoagulation therapy. In addition, there may be another 250,000 people who are undiagnosed. According to NICE, only an estimated 49.3% of patients with a history of AF are currently receiving anticoagulation therapy.