Continuous treatment with antidementia drugs in Germany 2003–2013: a retrospective database analysis

Bohlken, Jens; Weber, Simon; Rapp, Michael A.; Kostev, Karel

doi:10.1017/s1041610215000654

Cited by 28 publications

(26 citation statements)

References 27 publications

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“…In our cohort, almost 40% of patients discontinued treatment within 1 year. Interestingly, the proportion of patients who discontinued therapy within 1 year was similar in these different settings [4, 19, 20]. Our data suggests that memantine and rivastigmine had a risk of treatment discontinuation within 1 year that was higher than that of donepezil.…”

Section: Discussionsupporting

confidence: 51%

“…An outpatient claims database study in Germany examined the continuous treatment with AD drugs in over 12,000 patients aged 45 years or older with a dementia diagnosis between 2003 and 2013 [19]. It showed that 60% of the patients continued with the therapy after 1 year.…”

Section: Discussionmentioning

confidence: 99%

“…It showed that 60% of the patients continued with the therapy after 1 year. The patients on donepezil and memantine were less likely to discontinue treatment than those on rivastigmine were [19]. On the other hand, a study using a pharmacy claims database in the USA showed that newly treated patients with AD who received either rivastigmine or donepezil in a usual care setting had similar levels of treatment persistence [13].…”

Section: Discussionmentioning

confidence: 99%

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Prescription Patterns of Medications for Alzheimer’s Disease in Japan from 2010 to 2015: A Descriptive Pharmacy Claims Database Study

Kadohara

Sato

Doi³

et al. 2016

Neurol Ther

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IntroductionAlthough four kinds of Alzheimer’s disease (AD) drugs are available at present there was only one drug until 2011 in Japan. This study aimed to elucidate prescription trends of these medications for AD in Japanese outpatients before and after the new drug releases in 2011.MethodsThis descriptive study of pharmacy claims databases analyzed outpatient prescription data from community pharmacies across Japan. The study patients were 20 years or older and first administered medications for AD (donepezil, memantine, rivastigmine, or galantamine) between January 2010 and September 2014. They were grouped on the basis of the year of their initial medications for AD administration into the 2010–2011 and 2012–2014 groups (1 and 2, respectively) and their characteristics and AD treatments were summarized by group. The subanalyses used a multivariable logistic regression model to examine the relationship between patient characteristics and discontinuation or change to combination therapy within a year.ResultsA total of 103,592 patients (group 1 and 2, 28,581 and 75,011, respectively) were prescribed medications for AD during the study period. The group 1 and 2 mean ± standard deviation (SD) ages were 79.6 ± 7.4 and 80.9 ± 7.3 years while female patients constituted 64.0% and 64.5%, respectively. Furthermore, in groups 1 and 2 patients, 99.0% and 94.3% received a medication for AD monotherapy, 92.3% and 59.6% were prescribed donepezil, and 40.5% and 41.5% discontinued treatment within a year, respectively. The subanalyses suggest that being at least 85 years old strongly correlated with treatment discontinuation and change to combination therapy within a year.ConclusionAlthough the prescription proportions of the various medications for AD have changed since 2011, no apparent changes occurred in the patient characteristics of those who initiated AD treatment between 2010–2011 and 2012–2014.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prescription Patterns of Medications for Alzheimer’s Disease in Japan from 2010 to 2015: A Descriptive Pharmacy Claims Database Study

Kadohara

Sato

Doi³

et al. 2016

Neurol Ther

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“…This variability has to some extent been explained by the prescriber, which could reflect prescription of drugs which are contraindicated in combination with AChEIs, or by individual patient variability [4]. Moreover, discontinuation of AChEIs or switch to another AChEI can be related to environment (hospitalizations/change of care), medications (adverse drug reactions to AChEIs and inappropriate concurrent use of anticholinergic agents), and patient factors (cognitive decline, anxiety, and weight loss) [5, 6, 7, 8]. Rapid cognitive decline has been shown to be linked to switching [8], indicating that the decision to switch to another AChEI may be made for a potentially better therapeutic response.…”

Section: Introductionmentioning

confidence: 99%

Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors

Efjestad

Ihle‐Hansen

Hjellvik

et al. 2017

Dement Geriatr Cogn Disord Extra

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Background/Aims: Reduced clinical effect on cognitive decline in dementia by acetylcholinesterase inhibitors (AChEIs) may be due to concurrent use of drugs with anticholinergic properties. The aim was to analyze the incidence of AChEI use and comedication with drugs with anticholinergic properties and other potential unfavorable effects. Methods: A prospective study applying drug use data from the Norwegian Prescription Database. Anticholinergic Drug Scale (ADS) scores were used as a measure of overall anticholinergic burden. Results: Patients with high ADS scores were more frequently discontinuing treatment early. Coprescribing of antipsychotics was strongly associated with early discontinuation of AChEI treatment. Conclusion: Coprescribing with potentially unfavorable medications was common. A high ADS score was associated with early discontinuation of treatment.

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“…Research in the Republic of Ireland [20] found that rates of non-persistence with anti-dementia medications were 30.1% at 6 months and 43.8% at 12 months. Another recent study in Germany [21] showed that after 1 year of follow-up, nearly 60% of patients continued the antidementia treatment.…”

Section: Introductionmentioning

confidence: 99%

A Real-world Analysis of Treatment Patterns for Cholinesterase Inhibitors and Memantine among Newly-diagnosed Alzheimer’s Disease Patients

Bent‐Ennakhil¹,

Coste²,

Xie

et al. 2017

Neurol Ther

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IntroductionAlzheimer’s disease (AD) is the most common neurodegenerative form of dementia. Pharmacological therapies for symptomatic treatment, such as acetylcholinesterase inhibitors (AChEIs) and memantine, have been available in the USA since 2000. Over the past decade, few studies have analyzed real-world anti-dementia treatment patterns in the USA. This study evaluated monotherapy AChEIs and memantine treatment patterns among newly diagnosed AD patients.MethodsA retrospective cohort study was conducted using Medicare data and the Minimum Data Set from 2008 to 2012. Patients aged 65–100 years with newly diagnosed AD (ICD-9 code: 331.0) and monotherapy AChEI or memantine treatment initiated after diagnosis were included. Descriptive treatment pattern analyses, including discontinuation and switch, were undertaken. Kaplan–Meier curves were developed to examine the treatment duration.ResultsA total of 9812 newly diagnosed AD patients were identified, with 56.7% (n = 5567) first receiving anti-dementia treatment after the initial AD diagnosis. Among patients initiating monotherapy AChEIs or memantine after AD diagnosis (N = 5200), 51.6% continued index treatment during the entire follow-up period (mean follow-up: 659.7 days) and 21.7% discontinued treatment. Of those who initiated monotherapy treatment with an AChEI, 11.1% received adjunct therapy with memantine. Among patients with ≥1 year of continuous treatment (mean follow-up: 834 days), 75.6% remained on the index drug, 10.2% discontinued during the remaining follow-up period, and 9.5% of the AD patients initiating AChEIs received adjunct memantine therapy during the remaining follow-up period.ConclusionIn the USA Medicare population, about 50% of the patients who initiated treatment with AChEI or memantine after diagnosis continued the index treatment, and more than 20% discontinued and were untreated afterwards over the observation period. AD patients initiating AChEIs or memantine were more likely to remain on their treatment if they were persistently treated for the first year.Electronic supplementary materialThe online version of this article (doi:10.1007/s40120-017-0067-7) contains supplementary material, which is available to authorized users.

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Continuous treatment with antidementia drugs in Germany 2003–2013: a retrospective database analysis

Abstract: Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment.

Cited by 28 publications

References 27 publications

Prescription Patterns of Medications for Alzheimer’s Disease in Japan from 2010 to 2015: A Descriptive Pharmacy Claims Database Study

Prescription Patterns of Medications for Alzheimer’s Disease in Japan from 2010 to 2015: A Descriptive Pharmacy Claims Database Study

Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors

A Real-world Analysis of Treatment Patterns for Cholinesterase Inhibitors and Memantine among Newly-diagnosed Alzheimer’s Disease Patients

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