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Padovani A, Falato S, Pegoraro V. Extemporaneous combination of donepezil and memantine to treat dementia in Alzheimer disease: evidence from Italian real-world data. Curr Med Res Opin 2023; 39:567-577. [PMID: 36803101 DOI: 10.1080/03007995.2023.2182530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Providing evidence on donepezil and memantine administration as extemporaneous combination (DM-EXT) to treat Alzheimer Disease (AD) in Italy, and describing demographic and clinical features of AD patients prescribed DM-EXT. METHODS Retrospective observational study using IQVIA Italian LifeLink Treatment Dynamics (LRx) and Longitudinal Patient Database (LPD). Prevalent users of DM-EXT were identified on the databases (cohorts DMpLRx and DMpLPD) including patients with donepezil and memantine overlapping prescriptions during the selection period (DMpLRx: "July 2018-June 2021"; DMpLPD: "July 2012-June 2021"). Demographic and clinical profiles of patients were provided. Starting from cohort DMpLPD, new users of DM-EXT were selected to calculate treatment adherence. Three additional cohorts of prevalent users of DM-EXT were identified on IQVIA LRx over subsequent 12-month periods, from July 2018 to June 2021, to get national-level yearly estimates accounting for database representativeness. RESULTS Cohorts DMpLRx and DMpLPD included 9862 and 708 patients, respectively. For both cohorts, two-third of patients were female, and more than half were aged 80+. Concomitant conditions and co-treatments prevalence was very high; most frequent comorbidities included psychiatric and cardiovascular diseases. An intermediate-to-high adherence was observed in 57% of DM-EXT new users. National-level yearly estimates showed an increasing trend (+4%) in DM-EXT prescription, which led to estimate about 10,000 patients being treated during the period "July 2020-June 2021". CONCLUSIONS Prescription of DM-EXT is a common practice in Italy. Because the administration of fixed-dose (FDCs) instead of extemporaneous combinations improves treatment adherence, the introduction of an FDC containing donepezil and memantine might enhance AD patients' management and reduce caregiver burden.
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Affiliation(s)
- Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Serena Falato
- RWS Department, IQVIA Solutions Italy S.r.l, Milan, Italy
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Singh S, Yang F, Sivils A, Cegielski V, Chu XP. Amylin and Secretases in the Pathology and Treatment of Alzheimer's Disease. Biomolecules 2022; 12:996. [PMID: 35883551 PMCID: PMC9312829 DOI: 10.3390/biom12070996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Alzheimer's disease remains a prevailing neurodegenerative condition which has an array physical, emotional, and financial consequences to patients and society. In the past decade, there has been a greater degree of investigation on therapeutic small peptides. This group of biomolecules have a profile of fundamentally sound characteristics which make them an intriguing area for drug development. Among these biomolecules, there are four modulatory mechanisms of interest in this review: alpha-, beta-, gamma-secretases, and amylin. These protease-based biomolecules all have a contributory role in the amyloid cascade hypothesis. Moreover, the involvement of various biochemical pathways intertwines these peptides to have shared regulators (i.e., retinoids). Further clinical and translational investigation must occur to gain a greater understanding of its potential application in patient care. The aim of this narrative review is to evaluate the contemporary literature on these protease biomolecule modulators and determine its utility in the treatment of Alzheimer's disease.
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Affiliation(s)
| | | | | | | | - Xiang-Ping Chu
- Department of Biomedical Sciences, School of Medicine, University of Missouri, Kansas City, MO 64108, USA; (S.S.); (F.Y.); (A.S.); (V.C.)
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3
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Dufournet M, Moutet C, Achi S, Delphin-Combe F, Krolak-Salmon P, Dauphinot V. Proposition of a corrected measure of the Lawton instrumental activities of daily living score. BMC Geriatr 2021; 21:39. [PMID: 33430781 PMCID: PMC7802257 DOI: 10.1186/s12877-020-01995-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to propose a correction of the Lawton instrumental activity of daily living (IADL) score to take into account the possibility to have never done some activities, and measured its agreement and reliability with the usual IADL score. Methods A cross-sectional study was conducted in outpatients attending French memory clinics between 2014 and 2017. Lawton IADL, cognitive performance, diagnosis, neuropsychiatric symptoms, and sociodemographics characteristics were collected. A corrected IADL was calculated and its agreement with the usual IADL was assessed. Results The study included of 2391 patients (79.9 years old, 61.7% female). Based on the usual IADL, 36.9% of patients had never carried out at least one of the activities. This proportion reached 68.8% for men and 17.7% for women. Women had a mean IADL higher than men: 4.72 vs 3.49, this difference decreased when considering the corrected IADL: 4.82 vs 4.26 respectively. Based on Bland-Altman method, 93.5% of observations lied within the limits agreement. The ICC between the 2 scores was 0.98. The relationships between patients’ characteristics and the IADL scores were similar, regardless the usual or corrected version. Conclusions This corrected IADL score had an excellent degree of agreement with the usual version based the ICC. This simple correction could benefit both for the clinical practice by providing a more accurate description of the real clinical state of the patients allowing to manage them more precisely, and for research involving the evaluation of the functional abilities of patients.
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Affiliation(s)
- Marine Dufournet
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Claire Moutet
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Sarah Achi
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Floriane Delphin-Combe
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France.,Research Clinic Centre Aging Brain Frailty (CRC - VCF), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France.,University Lyon 1, INSERM, U1028, UMR CNRS 5292, Research Centre of Neurosciences of Lyon, Lyon, France
| | - Virginie Dauphinot
- Clinical and Research Memory Centre of Lyon of Lyon (CMRR Lyon), Lyon Institute For Elderly (Institut du vieillissement I-Vie), Hospices civils de Lyon, Lyon, France. .,Hôpital des Charpennes, 27 avenue Gabriel Péri, 69 100, Villeurbanne, France.
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4
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Removal of Drugs for Alzheimer’s Disease from the List of Reimbursable Drugs in France: Analysis of Change in Drug Use, Disease Management and Cognition Using the National Alzheimer Data Bank (BNA). Drugs Aging 2021; 38:63-74. [DOI: 10.1007/s40266-020-00817-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 01/06/2023]
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Description of the Treatment Course by Pregabalin for Anxiety in Patients With a Major Neurocognitive Disorder. J Clin Psychopharmacol 2019; 39:261-263. [PMID: 30939590 DOI: 10.1097/jcp.0000000000001029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anxiety symptoms frequently experienced by patients with a major neurocognitive disorder (NCD) are often treated with long-term benzodiazepines despite known adverse effects. Pregabalin has shown efficacy in generalized anxiety disorders but has not been studied in patients with a major NCD. The objective of this study was to describe the use of pregabalin for anxiety in patient with a major NCD and the impact of its use on the pharmacological treatment change. METHODS A retrospective study was conducted using data of hospitalized patients in a cognitive-behavioral specialized unit between January 2015 and December 2017. Patients with a major NCD treated by pregabalin were included in this study. Data about the use of pregabalin (initiation and effective dosage, titration duration) and the use of other psychotropics were collected from the patients' medical records. RESULTS Thirty-three patients were included (mean age, 79.6 ± 11.7 years; 66.7% women). The mean duration of pregabalin titration was 18.6 ± 1.4 days, and the mean effective dosage was 200.0 ± 130.8 mg/d (range, 50-700 mg/d). At admission (before pregabalin use), 78.8% of patients were treated with a systematic prescription of benzodiazepine. At discharge (with pregabalin use), a significant decrease in patients with systematic prescription of benzodiazepine was observed (78.8% vs 33.3%, P = 0.001). During hospitalizations, no pregabalin treatment has been discontinued for lack of efficacy or for tolerance. CONCLUSIONS Larger controlled studies are needed to confirm the efficacy and the safety of pregabalin to treat anxiety symptoms associated with neurocognitive disorders.
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Hampel H, Mesulam MM, Cuello AC, Farlow MR, Giacobini E, Grossberg GT, Khachaturian AS, Vergallo A, Cavedo E, Snyder PJ, Khachaturian ZS. The cholinergic system in the pathophysiology and treatment of Alzheimer's disease. Brain 2019; 141:1917-1933. [PMID: 29850777 DOI: 10.1093/brain/awy132] [Citation(s) in RCA: 909] [Impact Index Per Article: 181.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/29/2018] [Indexed: 12/19/2022] Open
Abstract
Cholinergic synapses are ubiquitous in the human central nervous system. Their high density in the thalamus, striatum, limbic system, and neocortex suggest that cholinergic transmission is likely to be critically important for memory, learning, attention and other higher brain functions. Several lines of research suggest additional roles for cholinergic systems in overall brain homeostasis and plasticity. As such, the brain's cholinergic system occupies a central role in ongoing research related to normal cognition and age-related cognitive decline, including dementias such as Alzheimer's disease. The cholinergic hypothesis of Alzheimer's disease centres on the progressive loss of limbic and neocortical cholinergic innervation. Neurofibrillary degeneration in the basal forebrain is believed to be the primary cause for the dysfunction and death of forebrain cholinergic neurons, giving rise to a widespread presynaptic cholinergic denervation. Cholinesterase inhibitors increase the availability of acetylcholine at synapses in the brain and are one of the few drug therapies that have been proven clinically useful in the treatment of Alzheimer's disease dementia, thus validating the cholinergic system as an important therapeutic target in the disease. This review includes an overview of the role of the cholinergic system in cognition and an updated understanding of how cholinergic deficits in Alzheimer's disease interact with other aspects of disease pathophysiology, including plaques composed of amyloid-β proteins. This review also documents the benefits of cholinergic therapies at various stages of Alzheimer's disease and during long-term follow-up as visualized in novel imaging studies. The weight of the evidence supports the continued value of cholinergic drugs as a standard, cornerstone pharmacological approach in Alzheimer's disease, particularly as we look ahead to future combination therapies that address symptoms as well as disease progression.
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Affiliation(s)
- Harald Hampel
- AXA Research Fund and Sorbonne University Chair, Paris, France.,Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital, Paris, France.,Brain and Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, Paris, France.,Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France
| | - M-Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - A Claudio Cuello
- Department of Pharmacology and Therapeutics, McGill University, Montreal, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Canada.,Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - Martin R Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ezio Giacobini
- Department of Internal Medicine, Rehabilitation and Geriatrics, University of Geneva Hospitals, Geneva, Switzerland
| | - George T Grossberg
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Ara S Khachaturian
- The Campaign to Prevent Alzheimer's Disease by 2020 (PAD2020), Potomac, MD, USA
| | - Andrea Vergallo
- AXA Research Fund and Sorbonne University Chair, Paris, France.,Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital, Paris, France.,Brain and Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, Paris, France.,Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France
| | - Enrica Cavedo
- AXA Research Fund and Sorbonne University Chair, Paris, France.,Sorbonne University, GRC n° 21, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Boulevard de l'hôpital, Paris, France.,Brain and Spine Institute (ICM), INSERM U 1127, CNRS UMR 7225, Boulevard de l'hôpital, Paris, France.,Institute of Memory and Alzheimer's Disease (IM2A), Department of Neurology, Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'hôpital, Paris, France
| | - Peter J Snyder
- Department of Neurology, Alpert Medical School of Brown University, Providence, RI USA.,Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA
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Évolution de la prise en charge médicamenteuse de la maladie d’Alzheimer en EHPAD : impact de la campagne médiatique contre les médicaments spécifiques de la maladie d’Alzheimer. Encephale 2017; 43:21-26. [DOI: 10.1016/j.encep.2015.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/23/2015] [Indexed: 01/09/2023]
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Jacquin-Piques A, Sacco G, Tavassoli N, Rouaud O, Bejot Y, Giroud M, Robert P, Vellas B, Bonin-Guillaume S. Psychotropic Drug Prescription in Patients with Dementia: Nursing Home Residents Versus Patients Living at Home. J Alzheimers Dis 2015; 49:671-80. [DOI: 10.3233/jad-150280] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Agnès Jacquin-Piques
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Guillaume Sacco
- Centre Mémoire de Ressource et de Recherche, EA CoBTeK, Université de Nice Sophia-Antipolis, Nice, France
| | - Neda Tavassoli
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Rouaud
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Yannick Bejot
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Maurice Giroud
- University Hospital of Dijon, Centre Mémoire de Ressources et de Recherches, Department of Neurology, Dijon, France
| | - Philippe Robert
- Centre Mémoire de Ressource et de Recherche, EA CoBTeK, Université de Nice Sophia-Antipolis, Nice, France
| | - Bruno Vellas
- Gérontopôle de Toulouse, Département de Médecine Interne et Gérontologie Clinique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sylvie Bonin-Guillaume
- University Hospital AP-HM, Department of Internal Medicine and Geriatrics, Aix Marseille University, Marseille, France
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Fink A, Doblhammer G. Risk of Long-Term Care Dependence for Dementia Patients is Associated with Type of Physician: An Analysis of German Health Claims Data for the Years 2006 to 2010. J Alzheimers Dis 2015; 47:443-52. [PMID: 26401566 DOI: 10.3233/jad-142082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As the population ages, the numbers of people developing care- and cost-intensive forms of dementia are raising. We investigated the pathways of incident dementia patients to long-term care (LTC) dependence and death, and examined the effects of: (1) the type of the main treating physician, differentiated by neurologists/psychiatrists (NPs) and non-NPs; (2) the prescription of antidementive drugs on the risk of needing LTC, differentiated by the degree of care need. Longitudinal claims data of the largest German public sickness fund of 10,043 incident dementia cases aged 60 years and above were analyzed for the years 2006 to 2010. Cox proportional hazard models were performed to investigate the risk of LTC and death based on what type of physician was treating the patient, and whether the patient was prescribed antidementive drugs; adjusted for age, gender, cardiovascular comorbidities, and the previous LTC level. The patients who were primarily treated by NPs had a significantly lower risk of LTC than patients who were mainly treated by non-NPs (considerable LTC: RR = 0.72, p = 0.000, severe LTC: RR = 0.78, p = 0.000, extreme LTC: RR = 0.67, p = 0.001). They generally had a lower risk of death. Antidementive drug treatment was correlated with an increased risk of LTC (considerable LTC: RR = 1.66, p = 0.000, severe LTC: RR = 1.50, p = 0.000, extreme LTC: RR = 1.48, p = 0.000) but with a decreased risk of death. A higher rate of involvement of specialists in the treatment of dementia patients is associated with a reduced LTC dependence and increased survival of dementia patients. Antidementive drug treatments appear to extend live years with dementia.
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Affiliation(s)
- Anne Fink
- German Center for Neurodegenerative Diseases (DZNE) Bonn, Bonn, Germany.,Rostock Center for the Study of Demographic Change, Rostock, Germany
| | - Gabriele Doblhammer
- German Center for Neurodegenerative Diseases (DZNE) Bonn, Bonn, Germany.,Rostock Center for the Study of Demographic Change, Rostock, Germany.,Institute for Sociology and Demography, University of Rostock, Rostock, Germany.,Max Planck Institute for Demographic Research, Rostock, Germany
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Wübbeler M, Wucherer D, Hertel J, Michalowsky B, Heinrich S, Meyer S, Schaefer-Walkmann S, Hoffmann W, Thyrian JR. Antidementia drug treatment in dementia networks in Germany: use rates and factors associated with treatment use. BMC Health Serv Res 2015; 15:205. [PMID: 25998147 PMCID: PMC4460966 DOI: 10.1186/s12913-015-0855-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/05/2015] [Indexed: 01/06/2023] Open
Abstract
Background Dementia networks in Germany constitute a specialised setting for integrated dementia care and have shown benefits on relevant outcomes, including those of drug treatment. National guidelines recommend treatment with acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) or the N-Methyl-D-Aspartate antagonist (memantine) to reduce cognitive symptoms. However, prescription rates are lower than 30 % in general practises. This study aims to describe antidementia drug treatment and the factors that are associated with the treatment in different dementia networks across Germany. Methods We have analysed the socio-demographic, clinical and utilisation data from 560 patients with dementia (PWD), as well as data from their caregivers, in 13 selected dementia networks in Germany. The patients and caregivers were interviewed in their homes or in the network facilities. Multiple logistic regression models were fitted to evaluate the socio-demographic and clinical factors associated with the utilisation of antidementia drug treatment in the various networks. Results In all of the networks in the study, 52 % of the participants received an antidementia drug treatment. Factors associated with the utilisation of the antidementia drug treatment were: formal diagnosis (OR = 16.81, p < 0.001), association with a physician in the network (OR = 3.69, p < 0.001), higher number of comorbidities (OR = 0.88, p = 0.039), living alone (OR = 0.51, p = 0.032) and higher age (OR = 2.97, p = 0.002). Conclusion Medical treatment of PWD with antidementia drugs in dementia networks in Germany is more frequent than in primary and nursing home care settings. Our findings also suggest that participants with a formal diagnosis and a physician in the network have increased rates of receiving antidementia drug treatments. These findings suggest that dementia networks focusing on medical treatment should support diagnostic procedures and incorporate physician specialists.
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Affiliation(s)
- Markus Wübbeler
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Interventional Health Care Research", Site Rostock/Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Steffen Heinrich
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Care Structures" Site Witten, Stockumer Str. 12, Witten, D-58453, Germany.
| | - Saskia Meyer
- Department of Human and Health Science, University of Bremen, Grazer Str. 4, Bremen, D-28359, Germany.
| | | | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany. .,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Interventional Health Care Research", Site Rostock/Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
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Fereshtehnejad SM, Johnell K, Eriksdotter M. Anti-dementia drugs and co-medication among patients with Alzheimer's disease : investigating real-world drug use in clinical practice using the Swedish Dementia Quality Registry (SveDem). Drugs Aging 2014; 31:215-24. [PMID: 24497071 DOI: 10.1007/s40266-014-0154-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is a substantial risk of drug-interactions, adverse events, and inappropriate drug use (IDU) among frail Alzheimer's disease (AD) patients; however, there are few studies about co-medication and IDU in clinical settings. OBJECTIVES To investigate anti-dementia drugs, associated characteristics of cholinesterase inhibitors (ChEIs) and NMDA antagonists, co-medication, and IDU in a large population of outpatients with mild AD. METHODS In this cross-sectional analysis of medication characteristics, we analyzed data from the Swedish Dementia Quality Registry (SveDem) on 5,907 newly diagnosed AD patients who were registered in memory clinics. SveDem is a national quality registry in Sweden, which was established in 2007 to evaluate and improve dementia healthcare. Comparisons were performed concerning co-medications, use of ≥3 psychotropic drugs (IDU) and polypharmacy (≥5 drugs) based on anti-dementia treatment (ChEIs or NMDA antagonists). Information on baseline characteristics such as age, sex, living conditions, cognitive evaluation based on the Mini-Mental State Examination (MMSE) score, and diagnostic work-up was also evaluated. RESULTS The majority of the AD patients were in the mild stage of the disease. Overall, 4,342 (75.4 %) patients received any ChEI, 438 (7.6 %) used an NMDA antagonist and 74 (1.3 %) patients were treated with both. However, 907 (15.7 %) patients were not treated with any anti-dementia drug. While polypharmacy was seen in 33.5 % of patients, only 2.6 % concurrently used ≥3 psychotropic medications. Patients on ChEIs were significantly younger, had a higher MMSE score and were treated with a smaller number of medications (a proxy for overall co-morbidity). Co-medication with antipsychotics [3.3 vs. 7.6 %; adjusted odds ratio (OR) 0.55 (95 % CI 0.38-0.79)] and anxiolytics [5.8 vs. 10.9 %; adjusted OR 0.62 (95 % CI 0.46-0.84)] was significantly lower in the ChEI+ group than in those with no anti-dementia treatment. CONCLUSION Patients taking ChEIs were treated with less antipsychotics and anxiolytics than those not taking ChEIs. More research is warranted to elucidate whether use of ChEIs in clinical practice can reduce the need for psychotropic drugs in AD patients.
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Affiliation(s)
- Seyed-Mohammad Fereshtehnejad
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Novum 5th floor, 14186, Stockholm, Sweden,
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Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study. Int Clin Psychopharmacol 2014; 29:216-23. [PMID: 24608822 PMCID: PMC4047310 DOI: 10.1097/yic.0000000000000032] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The objective of this study was to investigate the prevalence of acetylcholinesterase inhibitor (AChEI) and memantine use, duration of treatment, concomitant use of these drugs, and factors associated with the discontinuation of AChEI therapy during 2006-2009. We utilized data from a nationwide sample of community-dwelling individuals with a clinically verified Alzheimer's disease diagnosed during the year 2005 (n=6858) as a part of the MEDALZ-2005 study. During the 4-year follow-up, 84% used AChEI and 47% used memantine. Altogether, 22% of the sample used both drugs concomitantly. The median duration of the first AChEI use period was 860 (interquartile range 295-1458) days and 1103 (interquartile range 489-1487) days for the total duration of AChEI use. Although 20% of the AChEI users discontinued the use during the first year, over half of them restarted later. The risk of discontinuation was higher for rivastigmine [hazard ratio 1.34 (confidence interval 1.22-1.48)] and galantamine users [hazard ratio 1.23 (confidence interval 1.15-1.37)] compared with donepezil users in the adjusted model. In conclusion, median time for AChEI use was over 3 years and every fifth Alzheimer's disease patient used AChEI and memantine concomitantly during the follow-up. The low rate of discontinuation is consistent with the Finnish Care Guideline but in contrast to the results reported from many other countries.
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