Premium
Risk of Pneumonia in New Users of Cholinesterase Inhibitors for Dementia
Author(s) -
Lai Edward ChiaCheng,
Wong Monera B.,
Iwata Isao,
Zhang Yinghong,
Hsieh ChengYang,
Kao Yang YeaHuei,
Setoguchi Soko
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13380
Subject(s) - medicine , galantamine , rivastigmine , donepezil , hazard ratio , pneumonia , dementia , confidence interval , retrospective cohort study , emergency medicine , disease
Objectives To compare the risk of pneumonia in older adults receiving donepezil, galantamine, or rivastigmine for dementia. Design Retrospective cohort study. Setting Nationally representative 5% sample of M edicare databases. Participants Medicare beneficiaries aged 65 and older who newly initiated cholinesterase inhibitor therapy between 2006 and 2009. Measurements Pneumonia, defined as the presence of a diagnosis code for pneumonia as the primary diagnosis on an inpatient claim or on an emergency department claim followed by dispensing of appropriate antibiotics. Cox proportional hazards models were used to estimate the risk of pneumonia. Subgroup analyses and sensitivity analyses were conducted using alternative pneumonia definitions and adjustments using high‐dimensional propensity scores to test the robustness of the results. Results The mean age of 35,570 new users of cholinesterase inhibitors (30,174 users of donepezil, 1,176 users of galantamine, 4,220 users of rivastigmine) was 82; 75% were women, and 82% were white. The cumulative incidence of pneumonia was 51.9 per 1,000 person‐years. The risk of pneumonia for rivastigmine users was 24% lower than that of donepezil users (hazard ratio ( HR ) = 0.75, 95% confidence interval ( CI ) = 0.60–0.93). Risk in galantamine users ( HR = 0.87, 95% CI = 0.62–1.23) was not significantly different from risk in donepezil users. Results of subgroup and sensitivity analyses were similar to the primary results. Conclusion The risk of pneumonia was lower in individuals receiving rivastigmine than in those receiving donepezil. Additional studies are needed to confirm the findings of pneumonia risk between the oral and transdermal forms of rivastigmine and in users of galantamine.