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P4‐186: DONEPEZIL CAN IMPROVE DAILY ACTIVITIES AND PROMOTE REHABILITATION FOR SEVERE ALZHEIMER'S PATIENTS IN LONG‐TERM CARE HEALTH FACILITIES
Author(s) -
Meguro Kenichi,
Kasai Mari,
Akanuma Kyoko,
Meguro Mitsue,
Yamaguchi Satoshi
Publication year - 2014
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2014.05.1703
Subject(s) - donepezil , psychosocial , medicine , rehabilitation , dementia , physical therapy , activities of daily living , quality of life (healthcare) , intervention (counseling) , disease , psychiatry , nursing
Background:A previous report demonstrated better efficacy of 13.3 mg/24h versus 9.5 mg/24h patch on function and cognition in mild-to-moderate Alzheimer’s disease.1 Here we describe the efficacy and safety outcomes in declining patients treated with 13.3 mg/24h patch versus 9.5 mg/24h patch and memantine. Methods: In this retrospective analysis, patients declining and entering the double-blind phase, previously treated with 9.5mg/24h patch during the initial open label phase, werematched 1:1 (memantine users versus non-memantine) by means of propensity scores. The change from baseline in ADCS-IADL scale and ADAS-cog subscalewas assessed atWeeks 24 and 48 in patients treated with 13.3 mg/24h alone and those taking 9.5 mg/24h patch and memantine concomitantly (memantine was used at the investigator’s discretion). The use of memantine was not randomized. Data analysis was performed using ANCOVA including factors for treatment, country and baseline score of the respective efficacy parameter. Safety evaluations included incidence of adverse events (AEs) and serious AEs (SAEs).Results: 142 patients were included (71 per group). Gender, race, age, BMI andMMSEwere comparable between the two groups. 61.3% patients were female and 87.3% were 65 years. Patients treated with 13.3 mg/24h patch showed statistically greater benefit in function (ADCS-IADL) at weeks 24 and 48 versus those receiving concomitantly 9.5 mg/24h patch and memantine (Figure-1A). ADAS-cog outcomes were comparable between the two groups (Figure1B). The incidence rate of AEs, AEs leading to discontinuation and SAEs were 63.4 vs 54.9%, 2.8 vs 4.2% and 8.5 vs 8.5% in 13.3 mg/24h patch alone versus 9.5 mg/24h patch with concomitant memantine, respectively. Conclusions: Based on patients matched by propensity scores, this analysis found greater IADL benefit in patients up-titrated from 9.5 mg/24h to 13.3 mg/ 24h patch as compared to those receiving 9.5 mg/24h patch and concomitant memantine throughout. Although this analysis cannot replace a properly randomized trial, it suggests that a treatment regimen with up-titration from 9.5 mg/24h to 13.3 mg/24h patch may be more beneficial to AD patients compared to a regimen with combination of rivastigmine 9.5 mg/24h patch and memantine.1 Cummings J. et al. Dement Geriatr Cogn Disord.2012; 33(5):341-53.