Effectiveness and Safety of Cholinesterase Inhibitors in Elderly Subjects With Alzheimer’s Disease: A “Real World” Study

Mossello, Enrico; Tonon, Elisabetta; Caleri, Veronica; Tilli, Silvia; Cantini, Claudia; Cavallini, Maria Chiara; Bencini, Francesca; Mecacci, R.; Marini, Monica; Bardelli, F.; Sarcone, Eva; Razzi, Elena; Biagini, Carlo; Masotti, Giulio

doi:10.1016/j.archger.2004.04.040

Cited by 26 publications

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“…In terms of cognitive function and functionality of treated patients, some studies have shown similar results among the 3 ChEIs [33,37,38] , while other studies have shown a significant advantage for one of them: rivastigmine [36,39,40] , galantamine [34] or donepezil [35,40] . However, no strict comparisons have been done with memantine.…”

Section: Discussionmentioning

confidence: 86%

“…Four clinical trials [33][34][35][36] and studies in the clinical setting [37][38][39][40] have compared different ChEIs in terms of the cognitive and functional outcomes of patients; however, there is no agreement in their results, leaving the extent of each drug's effect undetermined. Patient-reported outcomes are important to understand the impact that the treatment has on the patient's functioning and wellbeing, providing valuable information for evaluating the adequacy of treatment outcomes [41] and for regulatory decisions [42,43] .…”

Section: Introductionmentioning

confidence: 99%

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Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Sevilla

Caballero²,

Alfonso³

et al. 2009

Dement Geriatr Cogn Disord

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Background/Aims: A full comparison of the satisfaction with treatment using the current Alzheimer’s disease (AD) therapies from the perspective of caregivers has not yet been done. The aim of this study was thus to find out the degree of satisfaction with the main available drug treatments in monotherapy for AD from this point of view. Methods: A cross-sectional, multicentre study of patients with possible/probable AD according to DSM-IV/NINCDS-ADRDA criteria, on monotherapy with donepezil, galantamine, rivastigmine or memantine, was carried out. Treatment satisfaction was measured by a caregiver proxy-administration of the generic SATMED-Q questionnaire [range: 0 (not satisfied at all) to 100 (totally satisfied)], overall and in 6 domains: tolerability, efficacy, medical care, ease and convenience, impact on daily activities and overall satisfaction. Results: A total of 829 patients were included: 63.3% women, aged 78.2 ± 6.8 years; 546 (67.3%) on donepezil, 106 (13.1%) on rivastigmine, 99 (12.2%) on galantamine and 60 (7.4%) on memantine. SATMED-Q scores p values were adjusted by MMSE and treatment duration. Caregivers of patients on donepezil showed significantly higher SATMED-Q total (71.8 ± 12.3; p < 0.05) and overall satisfaction domain scores (81.6 ± 18.4; p < 0.01) than those of patients on any other drugs, as well as significantly higher ease and convenience of use domain (81.5 ± 17.4; p < 0.01) and undesirable effects domain (96.0 ± 12.9; p < 0.05) scores than those of rivastigmine- and galantamine-treated patients. Of the caregivers of donepezil-treated patients, 76.7% were satisfied with treatment versus 68.7, 61.4 and 46.7% of those caregivers whose patients were treated with galantamine, rivastigmine and memantine, respectively (p = 0.0002). Conclusion: Caregivers of AD patients undergoing donepezil monotherapy seem to be more satisfied with treatment than those of patients receiving the other usual AD treatments in this study, particularly due to the ease and convenience of use of this drug. The higher level of satisfaction of these caregivers could be explained by the fact that, within the donepezil group, a high percentage of patients were treated with orally disintegrating tablets, which are easier for the patient to swallow.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Sevilla

Caballero²,

Alfonso³

et al. 2009

Dement Geriatr Cogn Disord

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“…Two of the included studies compared donepezil and rivastigmine only [23,24] , while the remaining 10 reported a head-to-head comparison of all 3 ChEIs [25][26][27][28][29][30][31][32][33][34] .…”

Section: Resultsmentioning

confidence: 99%

“…One study [34] was only available as an abstract and therefore reported limited study details, which resulted in a score of 4 on the NOS scale. The remaining 9 studies [23,[26][27][28][29][30][31][32][33] were judged to be of good quality (range: 7-9).…”

Section: Resultsmentioning

confidence: 99%

Safety and Tolerability of Donepezil, Rivastigmine and Galantamine for Patients with Alzheimer’s Disease: Systematic Review of the ‘Real-World’ Evidence

Lockhart

Mitchell

Kelly

2009

Dement Geriatr Cogn Disord

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Background/Aims: The purpose of this systematic review was to compare the safety and tolerability of the cholinesterase inhibitors (ChEIs) donepezil, rivastigmine and galantamine for treating mild to moderate Alzheimer’s disease (AD) patients in routine clinical practice. Methods: Electronic databases (Cochrane Library, Medline, EMBASE; accessed October 2008) and manual bibliographic searches were conducted to identify head-to-head non-randomised studies examining ChEIs for the treatment of AD. Data were extracted by 2 independent reviewers. Results: Twelve head-to-head studies comparing ChEIs met the pre-specified inclusion criteria; 6 retrospective analyses and 6 prospective cohort studies. Donepezil was the most widely studied treatment and galantamine the least widely prescribed therapy. Fewer donepezil-treated subjects withdrew due to adverse events (AEs) compared with rivastigmine and galantamine-treated subjects. The incidence of gastrointestinal (GI) AEs was lower following treatment with donepezil compared with rivastigmine and galantamine. Non-GI (CNS and cardiovascular) AEs occurred at a low frequency, and had a similar incidence in subjects treated with the different ChEIs. Conclusions: Subjects with mild to moderate AD treated in routine clinical practice with donepezil were more adherent to pharmacotherapy, and had a lower risk of GI AEs compared with rivastigmine or galantamine. This finding accords with results reported in the randomised clinical trial literature.

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“…The clinical benefit of reaching higher doses from a QoL perspective is supported by a large 3-year, prospective, observational study of 880 patients with AD treated with CIs, in which a higher dose of CIs (donepezil >6.9 mg/ day, oral rivastigmine >6 mg/day, galantamine >16 mg/day) was independently associated with a lower institutionalization risk [Wattmo et al 2011]. The risk of gastrointestinal side effects leading to treatment withdrawal is particularly high for the oral formulation of rivastigmine, both in clinical trials [Birks et al 2009] and in clinical practice [Mossello et al 2004]. In this regard, the introduction of a transdermal formulation of rivastigmine has represented a relevant advantage, allowing the administration of higher, more efficacious doses with a reduction of adverse events by two-thirds in comparison with capsules [Winblad et al 2007].…”

Section: Adverse Events Risk Versus Efficacymentioning

confidence: 99%

Management of patients with Alzheimer’s disease: pharmacological treatment and quality of life

Mossello¹,

Ballini

2012

Therapeutic Advances in Chronic Disease

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Abstract:A methodological approach to quality of life (QoL) assessment in Alzheimer's disease (AD) is challenging and few clinical trials have included it among outcomes, with conflicting results. In this review an indirect appraisal of evidence has been performed, searching the literature for the effect of drug treatments on determinants of QoL in AD. Among clinical factors associated with QoL, possible targets of drugs include cognition, which seems to be associated with QoL in early disease and can be positively affected by cholinesterase inhibitors (CIs) in this stage; functional decline, the risk of which can be decreased by CIs and memantine (MEM); behavioral and psychological symptoms, which can be reduced by MEM and atypical antipsychotics. Long-term observational studies have associated CIs and MEM treatment with a reduced institutionalization risk. According to the evidence, drug treatment of depression associated with AD should not be first choice from a QoL perspective, while treatment of pain can have beneficial effects on wellbeing indicators also in the late stages of the disease. Possible drug-related adverse events can affect QoL and should always be weighed against expected benefits from the patient's perspective. For this reason antipsychotic treatment is often problematic in AD and should be limited to severe psychosis and aggression, using the lowest effective doses for the shortest possible period. Conversely titration of CIs is necessary to reach the most effective dosages, although dose-related risk of adverse events has to be taken into account. Finally, CIs and MEM have been shown to reduce caregiver burden in randomized trials, possibly affecting caregivers' QoL.

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Effectiveness and Safety of Cholinesterase Inhibitors in Elderly Subjects With Alzheimer’s Disease: A “Real World” Study

Cited by 26 publications

References 0 publications

Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Safety and Tolerability of Donepezil, Rivastigmine and Galantamine for Patients with Alzheimer’s Disease: Systematic Review of the ‘Real-World’ Evidence

Management of patients with Alzheimer’s disease: pharmacological treatment and quality of life

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