Real-world evaluation of compliance and preference in Alzheimer’s disease treatment

Abstract

PurposeRivastigmine transdermal patch has shown higher caregiver satisfaction and greater preference than oral formulation in patients with Alzheimer’s disease. However, there is limited literature available related to caregiver preference or treatment compliance in real-world clinical settings. To date, no such data are available from Asia and the Middle East, which account for a sizeable proportion of patients with Alzheimer’s disease. The objective of this study was to evaluate treatment preference and compliance with oral and transdermal medications in daily clinical practice in an ethnically diverse patient population from Asia and the Middle East with mild-to-moderate Alzheimer’s disease.Patients and methodsRECAP (Real-world Evaluation of Compliance And Preference in the treatment of Alzheimer’s disease) was a 24-week, multicenter, prospective, noninterventional study. Two treatment cohorts were observed during the study: oral (cholinesterase inhibitors or memantine) and transdermal (rivastigmine patch). Caregiver preference, physician preference, and patient compliance were evaluated at week 24.ResultsA total of 978 of 1,931 enrolled patients (mean age: 72.8 years; 50.5% female) were in the transdermal cohort. For patients with exposure to both oral and transdermal monotherapy (n=330), a significant caregivers’ preference for the transdermal monotherapy was observed (82.7%; P<0.0001). Of the 89 participating physicians, 71 indicated preference for transdermal monotherapy. Patient compliance was also significantly higher for transdermal than oral monotherapy (P<0.0001).ConclusionOur study showed higher caregiver and physician preference and greater patient compliance with transdermal monotherapy in daily practice.

Real-world evaluation of compliance and preference in Alzheimer&rsquo;s disease treatment: an&nbsp;observational study in Taiwan&nbsp;

“…The overall patient compliance in the current study was good in both the treatment cohorts, unlike other studies including AXEPT 20 and global RECAP 13 that showed greater patient compliance with rivastigmine transdermal patch over other oral medications as indicated by the caregivers of patients with AD. Results from the ENTERPRISE study 21 also showed high compliance rates (60.5%) with transdermal rivastigmine patch compared with the oral formulation.…”

“…Previously, the IDEAL, 12 Alzheimer disease: eXamination of patiEnt comPliance and caregiver satisfacTion (AXEPT), 20 Effective Management of Alzheimer’s Disease By TReating pAtients and relieving Caregivers with Exelon Patch (EMBRACE), 19 ENTERPRISE, 21 global RECAP study, 13 and an observational clinical study 22 have assessed the caregiver preference and/or satisfaction for the treatment of AD. IDEAL was the first pivotal trial 17 , 23 to demonstrate the non-inferiority of the rivastigmine transdermal patch over oral capsules; the study 12 also showed higher caregivers’ preference (72%) for the rivastigmine transdermal patch compared with oral capsules.…”

“…Higher gastrointestinal AEs were noted in the oral monotherapy cohort compared with the transdermal monotherapy cohort (n=21 [12.9%] versus n=7 [5.1%], respectively), as observed in a previously reported study. 13 …”

“…The details of the statistical power associated with sample size were described elsewhere. 13 Summary statistics for continuous variables were presented as number of observations (n), arithmetic mean, and standard deviation (SD), and categorical variables were presented as absolute and relative frequencies. In addition, two-sided 95% confidence intervals (CIs) as well as P -values were presented for the caregiver preferences for the oral or transdermal patch.…”

“…The Real-world Evaluation of Compliance And Preference in Alzheimer’s disease treatment (RECAP) study is a noninterventional, observational study that evaluated caregiver preference, compliance, safety, and effectiveness in patients with AD treated with either oral or transdermal monotherapy. 13 The study was conducted in Taiwan, India, Egypt, South Korea, Lebanon, and Singapore.…”