Persistence with cholinesterase inhibitor therapy in a population‐based cohort of patients with Alzheimer's disease

Amuah, Joseph E.; Hogan, David B.; Eliasziw, Misha; Supina, Alison L; Beck, Patricia; Downey, Winanne; Maxwell, Colleen J.

doi:10.1002/pds.1946

Cited by 55 publications

(74 citation statements)

References 49 publications

(120 reference statements)

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“…Stopping treatment may have occurred because of the apparent lack of effectiveness. Interestingly, the lower risk for ChEI discontinuation observed for older patients with AD in the study by Amuah et al 44 was only apparent in analyses restricted to those who remained eligible for coverage (that is, did not show evidence of decline in both their cognitive and functional abilities).…”

Section: Patient-level Factorsmentioning

confidence: 95%

“…While many studies reported no statistically significant association between ChEI persistence and age or sex, several reports suggest that older patients (for example, aged 75 and older) 34,38,39,45,46,50,53 and female patients 34,43,44 may be more likely to discontinue ChEI therapy. An association with advanced age may reflect the impact of more advanced disease severity, 31 a perceived lack of therapeutic benefit, or concerns about a heightened risk for adverse effects.…”

Section: Patient-level Factorsmentioning

confidence: 99%

“…62,64 In the study by Amuah et al, 44 patients with AD paying for a greater proportion of their total prescription costs were significantly more likely to discontinue ChEI therapy. Studies of other drug classes have shown strong associations between worse adherence and (or) persistence and financial barriers in older, vulnerable patient groups.…”

Section: Patient-level Factorsmentioning

confidence: 99%

“…The possibility of socioeconomic barriers to dementia pharmacotherapy have been reported in Canadian 37,44 and US studies. 62,64 In the study by Amuah et al, 44 patients with AD paying for a greater proportion of their total prescription costs were significantly more likely to discontinue ChEI therapy.…”

Section: Patient-level Factorsmentioning

confidence: 99%

“…An association with advanced age may reflect the impact of more advanced disease severity, 31 a perceived lack of therapeutic benefit, or concerns about a heightened risk for adverse effects. The few reports of greater ChEI persistence 44 or adherence 62 with increased age could be explained by modifying factors such as greater caregiver involvement in medication management, which has been linked with both higher ChEI use 69 and better adherence. 29,71 Unfortunately, information on the degree of caregiver involvement is generally not available in these studies.…”

Section: Patient-level Factorsmentioning

confidence: 99%

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Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

et al. 2014

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This paper provides a comprehensive review of studies examining adherence and (or) persistence with dementia pharmacotherapy during the past decade, including a summary of the key patient-, drug-, system-, and provider-level factors associated with these measures. Estimates of adherence and 1-year persistence to these drugs have ranged from 34% to 94% and 35% to 60%, respectively. Though many studies reported nonsignificant associations, there are data suggesting that patient age, sex, ethnoracial background, socioeconomic status, and region-specific reimbursement criteria, as well as the extent and quality of interactions among patients, caregivers, and providers, may influence persistence with pharmacotherapy. As many studies relied on administrative data, limited information was available regarding the relevance of patient's cognitive and functional status or the importance of caregiver involvement or assistive devices to adherence or persistence. W W WPersistance et observance de la pharmacothérapie de la démence : pertinence des facteurs liés au patient, au fournisseur, et au système Cet article offre une revue détaillée des études examinant l'observance et (ou) la persistance de la pharmacothérapie de la démence au cours des dix dernières années, dont un résumé des principaux facteurs au niveau du patient, du médicament, du système et du fournisseur qui sont associés à ces mesures. Les estimations de l'observance et de la persistance d'un an à ces médicaments allaient de 34 % à 94 % et de 35 % à 60 %, respectivement. Même si de nombreuses études faisaient état d'associations non significatives, des données suggèrent que l'âge, le sexe, les origines ethnoraciales, le statut économique des patients et leurs critères de remboursement régionaux, ainsi que l'étendue et la qualité des interactions entre patients, soignants, et fournisseurs peuvent influencer la persistance de la pharmacothérapie. Comme bon nombre d'études s'appuyaient sur des données administratives, l'information disponible était limitée en ce qui concerne la pertinence de l'état cognitif et fonctionnel du patient, ou l'importance de l'implication du soignant ou des dispositifs d'assistance à l'observance ou à la persistance. In 2008, the estimated number of people with dementia in Canada was nearly half a million.2 Ensuring appropriate pharmacotherapy is an important component of care for people with dementia.3,4 ChEIs (for example, donepezil, rivastigmine, and galantamine) and the N-methyl-daspartate receptor antagonist memantine are approved for the symptomatic treatment of AD. 3,4 Recommendations made at the fourth CCCDTD (in 2012) included offering all people with AD a trial of a ChEI unless there are contraindications, using these agents for Parkinson disease dementia, and considering memantine for AD at a moderateto-severe stage. 5Investigating adherence and persistence with dementia pharmacotherapy is important in understanding both the therapeutic benefits and the cost-effectiveness of these medications. As symptomatic therapies, trea...

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Section: Patient-level Factorsmentioning

confidence: 95%

Section: Patient-level Factorsmentioning

confidence: 99%

Section: Patient-level Factorsmentioning

confidence: 99%

Section: Patient-level Factorsmentioning

confidence: 99%

Section: Patient-level Factorsmentioning

confidence: 99%

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Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

et al. 2014

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Impact of deprescribing AChEIs on aggressive behaviors and antipsychotic prescribing

Niznik

Zhao

et al. 2020

Alzheimer's & Dementia

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Introduction We evaluated the impact of deprescribing acetylcholinesterase inhibitors (AChEIs) on aggressive behaviors and incident antipsychotic use in nursing home (NH) residents with severe dementia. Methods We conducted a retrospective study of Medicare claims, Part D, Minimum Data Set for NH residents aged 65+ with severe dementia receiving AChEIs in 2016. Aggressive behaviors were measured using the aggressive behavior scale (ABS; n = 30,788). Incident antipsychotic prescriptions were evaluated among antipsychotic non‐users (n = 25,188). Marginal structural models and inverse probability of treatment weights were used to evaluate associations of AChEI deprescribing and outcomes. Results The severity of aggressive behaviors was low at baseline (mean ABS = 0.5) and was not associated with deprescribing AChEIs (0.002 increase in ABS, P = .90). Incident antipsychotic prescribing occurred in 5.1% of residents and was less likely with AChEI deprescribing (adjusted odds ratio = 0.52 [0.40–0.68], P <.001]). Discussion Deprescribing AChEIs was not associated with a worsening of aggressive behaviors or incident antipsychotic prescriptions.

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Current awareness in geriatric psychiatry

2010

Int J Geriat Psychiatry

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In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Reviews; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted

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Persistence with cholinesterase inhibitor therapy in a population‐based cohort of patients with Alzheimer's disease

Abstract: The likelihood of discontinuing ChEI therapy was high in this real-world sample of AD patients. Significant predictors included clinical, socioeconomic, and practice factors.

Cited by 55 publications

References 49 publications

Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

Impact of deprescribing AChEIs on aggressive behaviors and antipsychotic prescribing

Current awareness in geriatric psychiatry

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