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Discontinuation of rivastigmine in routine clinical practice
Author(s) -
Frankfort Suzanne V.,
Appels Bregje A.,
de Boer Anthonius,
Tulner Linda R.,
van Campen Jos. P. C. M.,
Koks Cornelis H. W.,
Beijnen Jos H.
Publication year - 2005
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.1411
Subject(s) - discontinuation , rivastigmine , medicine , clinical practice , psychology , pediatrics , dementia , physical therapy , donepezil , disease
Background Rivastigmine is used for symptomatic treatment of mild‐to‐moderately severe Alzheimer's Dementia (AD). We investigated the frequeny of and reasons for rivastigmine discontinuation in clinical practice and possible predictive factors for discontinuation within the first six months after starting therapy. Methods A retrospective cohort study was performed in rivastigmine users, who started therapy in a naturalistic setting. A nurse supported a part of the studied cohort, as this was introduced during the study period. Reasons for discontinuation were investigated, including therapy discontinuation if the Maximum Achieved Dose (MAD) was below 6 mg daily. Predictors of discontinuation within the first half year were investigated by logistic regression analysis. Results Baseline Mini‐Mental‐State‐Examination (MMSE) of included patients ( n = 154) was 20.1, mean age was 78.4 years and 70% was female. Within 6 months, 61 users (39.6%) discontinued therapy, primarily (59.0%) for adverse events. Thereafter, the main reason for discontinuation was non‐response according to clinimetrics. A MAD during the titration phase of 1.5–4.5 mg/day and absence of nurse support are significantly related to discontinuation within 6 months. Conclusions Rivastigmine is primarily discontinued within the first six months for intolerable adverse events and thereafter mainly for ongoing deterioration. A MAD of 1.5–4.5 mg/day and the absence of nurse support are independently related to discontinuation of rivastigmine within the initial 6 months. Copyright © 2005 John Wiley & Sons, Ltd.