[对接受多奈哌齐、卡巴拉汀、加兰他敏和美金刚治疗的西班牙阿尔茨海默病患者抗痴呆药物持续治疗模式的回顾性比较分析]

[Retrospective comparative analysis of antidementia medication persistence patterns in Spanish Alzheimer's disease patients treated with donepezil, rivastigmine, galantamine and memantine].

作者信息

Sicras-Mainar A, Vergara J, Leon-Colombo T, Febrer L, Rejas-Gutierrez J

机构信息

Badalona Serveis Assistencials, 08911 Badalona, Espana.

出版信息

Rev Neurol. 2006;43(8):449-53.

PMID:17033976

Abstract

INTRODUCTION AND AIM

Dementia of Alzheimer type has become the most frequent type of dementia in our environment. Treatment persistence is a crucial factor to delay patient functional and cognitive impairment. The aim of the present study was to determine treatment persistence in usual care settings with four different antidementia drugs: donepezil, rivastigmine, galantamine and memantine in a cohort of patients with Alzheimer's dementia in Spain.

PATIENTS AND METHODS

An Alzheimer type dementia retrospective cohort study was performed in 13 Primary Care Health Centers in Spain. The study included patients treated between January 2000 and March 2005.

RESULTS

A total of 299 patients (44.8% female), mean age 77.9 years, were included: 101 donepezil (33.8.%), 105 rivastigmine (35.1%), 51 galantamine (17.1%) and 42 memantine (14.0%). Mean treatment duration was significantly different depending on therapy type, showing higher values for donepezil patients (mean: 83.3 weeks; 95% CI: 72.7-93.9) than for the other cholinesterase inhibitors: rivastigmine (mean: 76.6 weeks; 95% CI: 66.0-87.3), galantamine (mean: 65.8 weeks; 95% CI: 55.3-76.3) and memantine (60.9 weeks; 95% CI: 48.8-73.1), p = 0.049. Overall treatment persistence was significantly different between drugs, with again donepezil showing higher persistence (median time: 70.3 weeks; 95% CI: 49.8-90.7) than with the others drugs: rivastigmine (median time: 56.1 weeks; 95% CI: 36.1-76.2), galantamine (median time: 56.7 weeks; 95% CI: 41.1-72.3) and memantine (median time: 52.1 weeks; 95% CI: 35.2-69.1), log-rank = 10.16; p = 0.017.

CONCLUSION

This study showed significative differences in the global treatment persistence among the considered drug-cholinesterase inhibitors, showing higher persistence resulting in patients treated with donepezil compared to those who received rivastigmine, galantamine or memantine.

摘要

引言与目的

在我们所处的环境中，阿尔茨海默病型痴呆已成为最常见的痴呆类型。治疗依从性是延缓患者功能和认知障碍的关键因素。本研究的目的是确定在西班牙一组阿尔茨海默病痴呆患者中，使用四种不同抗痴呆药物（多奈哌齐、卡巴拉汀、加兰他敏和美金刚）在常规护理环境下的治疗依从性。

患者与方法

在西班牙的13个初级保健健康中心进行了一项阿尔茨海默病型痴呆回顾性队列研究。该研究纳入了2000年1月至2005年3月期间接受治疗的患者。

结果

共纳入299例患者（女性占44.8%），平均年龄77.9岁：101例使用多奈哌齐（33.8%），105例使用卡巴拉汀（35.1%），51例使用加兰他敏（17.1%），42例使用美金刚（14.0%）。平均治疗持续时间因治疗类型而异，多奈哌齐患者的平均治疗持续时间显著更长（平均：83.3周；95%置信区间：72.7 - 93.9），高于其他胆碱酯酶抑制剂：卡巴拉汀（平均：76.6周；95%置信区间：66.0 - 87.3）、加兰他敏（平均：65.8周；95%置信区间：55.3 - 76.3）和美金刚（60.9周；95%置信区间：48.8 - 73.1），p = 0.049。不同药物之间的总体治疗依从性存在显著差异，多奈哌齐的依从性再次高于其他药物：卡巴拉汀（中位时间：56.1周；95%置信区间：36.1 - 76.2）、加兰他敏（中位时间：56.7周；95%置信区间：41.1 - 72.3）和美金刚（中位时间：52.1周；95%置信区间：35.2 - 69.1），对数秩 = 10.16；p = 0.017。