Patterns of cholinesterase-inhibitor use in the nursing home setting: A retrospective analysis

Trends and disparities in the use of cholinesterase inhibitors to treat Alzheimer’s disease dispensed by the Brazilian public health system – 2008 to 2014: a nation-wide analysis

“…This pattern of increased treatment is also In regard to the types of cholinesterase inhibitors prescribed, we found that in Brazil, the most frequently-used drug was rivastigmine, at more than 47% of prescriptions. On the other hand, donepezil was the most common drug (greater than 50%) 11 in European countries like Belgium, France, Germany, Italy, the Netherlands, Poland, Portugal, Spain, and the United Kingdom in 2004, a result similar to that of the United States (66.3%) 15 . The decision for the use of cholinesterase inhibitors, independent of AD severity, should be based on each professional's experience 16 and studies have still failed to demonstrate greater effectiveness of one drug over the other 17 .…”

Comparison of Cholinesterase Inhibitor Utilization Patterns and Associated Health Care Costs in Alzheimer's Disease

“…Finally, the results of the present study in a community-dwelling population replicate those seen in a recent publication by Dybicz et al, which showed that those patients living in an institution or nursing home and treated with donepezil reached an effective dose (as defined in FDA-approved product labeling) in less time than did patients treated with the other ChEIs. 16 The significance of some adherence measures and lack of significance of others indicates the need to include multiple adherence measures in a study. The use of multiple adherence measures is a key feature of this study that makes it distinctive from other ChEI adherence studies.…”

Treatment of Alzheimer’s disease in the long-term-care setting

“…Similar proportions of patients receiving each medication discontinued ChEI therapy during the study period (43.1% of donepezil-treated, 46.2% of rivastigmine-treated, and 47.0% of galantamine-treated patients). 42 These results suggest that administration of ChEIs in nursing homes is not optimal and that many nursinghome residents may be withdrawn from ChEI treatment before an effective dosage is reached. Interpretation of this study is limited in that the results were based solely on prescription claims data and the study neither controlled for bias in medication assignment nor identified why patients discontinued medications.…”

“…41,42 However, evidence suggests that AD treatments are generally underused in LTC facilities. Using MDS data from more than 170,000 patients, Pedone et al 43 observed that, among patients meeting the labeled indication for use at the time of the study (i.e., mild-tomoderate AD), donepezil was given to only 30% of newly admitted patients and 19% of long-stay patients.…”

“…Improper dosage adjustments of AD treatments were observed in a large-scale, retrospective study (n = 2873) of nursinghome residents who were prescribed ChEI therapy. 42 The effective daily dosages of donepezil, rivastigmine, and galantamine were defined as ≥5, ≥6, and ≥16 mg, respectively. Results of this study indicated that the time to effective dosage was delayed in patients receiving rivastigmine and galantamine, with only 63.4% of rivastigmine-treated and 55.7% of galantamine-treated patients receiving an effective dose by the third month of therapy (versus 99.1% of donepezil-treated patients) (p < 0.001).…”