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Published in: CNS Drugs 2/2014

01-02-2014 | Original Research Article

A 2-Year Prospective Cohort Study of Antidementia Drug Non-Persistency in Mild-to-Moderate Alzheimer's Disease in Europe

Predictors of Discontinuation and Switch in the ICTUS Study

Authors: Virginie Gardette, Maryse Lapeyre-Mestre, Antoine Piau, Adeline Gallini, Christelle Cantet, Jean-Louis Montastruc, Bruno Vellas, Sandrine Andrieu, The ICTUS Group

Published in: CNS Drugs | Issue 2/2014

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Abstract

Background

There is no consensus on when and how to discontinue cholinesterase inhibitors (ChEI). Predictors of non-persistency of antidementia drugs have been poorly investigated, mostly during short-term periods and using administrative data.

Objective

The aim of this study was to investigate the incidence and predictors of ChEI switch and discontinuation among subjects with ascertained Alzheimer’s disease (AD).

Methods

A total of 557 community-dwelling, mild-to-moderate AD subjects initiating ChEIs in 29 European clinic centres were assessed twice-yearly for 2 years. Antidementia drug exposure was recorded through a physician-administered structured questionnaire to document any change in drug therapy (start and stop dates, reasons). Discontinuation was defined as >35 days without any antidementia drug. Switch was defined as a change for any antidementia drug strategy within 35 days after ChEI cessation. Two separate time-dependent multivariate Cox survival analyses were conducted to identify predictors of discontinuation and switch.

Results

The incidences of discontinuation and switch were 9.65 and 12.47/100 person-years, respectively. Behavioural disturbances, low body mass index, falls, decline in Mini-Mental State Examination (MMSE) score, and AD-related hospitalization predicted discontinuation. MMSE score, decline in activities of daily living score, aberrant motor behaviour, shorter AD duration and higher nurse resource use predicted a switch. An ineffective ChEI dose and clinic specialty predicted both outcomes. Sensitivity analyses using a 60-day cut-off provided stable results.

Conclusion

Several predictors were identified: adverse drug events and their predisposing factors, perceived loss of efficacy or disease progression on cognitive or functional scales, behavioural disturbances, hospitalization and professional practices. The latter implies a need for harmonization in AD drug prescription practice.
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Metadata
Title
A 2-Year Prospective Cohort Study of Antidementia Drug Non-Persistency in Mild-to-Moderate Alzheimer's Disease in Europe
Predictors of Discontinuation and Switch in the ICTUS Study
Authors
Virginie Gardette
Maryse Lapeyre-Mestre
Antoine Piau
Adeline Gallini
Christelle Cantet
Jean-Louis Montastruc
Bruno Vellas
Sandrine Andrieu
The ICTUS Group
Publication date
01-02-2014
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 2/2014
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-013-0133-3

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