Biased Results Owing to Competing Interests?
On the basis of the results of a selective literature search, the authors recommend in patients with renal insufficiency (creatinine clearance >25–30 mL/min) the preferential use of NOAC in atrial fibrillation (1). In this, they take recourse—among others—to the guideline of the European Society of Cardiology (ESC), whose quality and validity is restricted by the fact (among others) that all guideline authors, including the lead authors, have relevant financial conflicts of interest, and the ESC does not apply rules on how to deal with conflicts of interest (2). The authors of the present article also have relevant conflicts of interest: Professor Heine has received moneys from two NOAC manufacturers, Professor Brandenburg from three NOAC manufacturers, and Dr. Schirmer from all five NOAC manufacturers. The result of their selective literature search reflects the interests of the pharmaceutical companies.
Their findings contradict the recommendations of authors who did not receive moneys from NOAC manufacturers—for example, the Drug Commission of the German Medical Association, and, with only one exception, the working group “Heart-Kidney” of the German Society for Cardiology—Heart and Circulatory Research and the German Society of Nephrology (3, 4). These authors advise against the use of any NOAC in a creatinine clearance <30 mL/min. Other experts too recommend preferential use of vitamin K antagonists for the purpose of anticoagulation in patients with renal insufficiency (Der Arzneimittelbrief 2017, 51, 87).
Particularly if there is insufficient evidence from studies, recommendations for the treatment of patients should be made only by authors who do not have any conflicts of interest owing to financial relationships with pharmaceutical companies.
Dr. med. Gisela Schott, MPH
Arzneimittelkommission der deutschen Ärzteschaft, Berlin
Dr.med. Niklas Schurig
Conflict of interest statement
Dr Schott is a member of MEZIS and collaborates in Leitlinienwatch [guideline watch, https://www.leitlinienwatch.de/].
Dr Schurig is a board member in MEZIS and collaborates in Leitlinienwatch.
|1.||Heine GH, Brandenburg V, Schirmer SH: Oral anticoagulation in chronic kidney disease and atrial fibrillation—the use of non-vitamin K-dependent anticoagulants and vitamin K antagonists. Dtsch Arztebl Int 2018; 115: 287–94 VOLLTEXT|
|2.||ESC-Leitlinienbeurteilung bei leitlinienwatch.de; www.leitlinienwatch.de/esc-leitlinie-zum-management-des-vorhofflimmerns-esc-guidelines-for-the-management-of-atrial-fibrillation/ (last accessed on 11 May.2018).|
|3.||Leitfaden „Orale Antikoagulation bei nicht valvulärem Vorhofflimmern“ (2nd, revised edition 2016), https://akdae.de/Arzneimitteltherapie/LF/PDF/OAKVHF.pdf (last accessed on 11 May.2018).|
|4.||Schlieper G, Schwenger V, Remppis A: [Anticoagulation in patients with chronic kidney disease: Recommendations from the working group „Heart-Kidney“ of the German Cardiac Society and the German Society of Nephrology]. Internist 2017; 58: 512–21 CrossRef MEDLINE|