Department of Neurology, Ohio State University, Columbus, Ohio 43210, USA.
Drugs Aging. 2010 Nov 1;27(11):903-13. doi: 10.2165/11584290-000000000-00000.
Rivastigmine and donepezil are two cholinesterase inhibitors (ChEIs) indicated for the treatment of mild-to-moderate Alzheimer's disease. Dementia-related behavioural issues are typically managed by environmental modification and the use of psychotropics including antipsychotic medications. However, ChEIs have also been associated with reductions in behavioural symptoms in Alzheimer's disease patients. This retrospective, parallel-cohort, hypothesis-generating study investigated whether treatment with rivastigmine is associated with reduced prescription of antipsychotic medications compared with treatment with donepezil.
A combined analysis of two claims databases was conducted. Patients were included if they had a diagnosis of Alzheimer's disease and were newly initiated on either rivastigmine or donepezil. Patients with prior use of memantine and/or antipsychotics were excluded. Kaplan-Meier and Cox analyses were conducted to compare the rate of antipsychotic drug use between the rivastigmine and donepezil groups.
A total of 956 patients receiving rivastigmine and 12 778 patients receiving donepezil formed the study population. Analysis revealed that 64 (6.7%) rivastigmine and 989 (7.7%) donepezil recipients received antipsychotic medications (log-rank test from Kaplan-Meier analysis, p = 0.2289). The Cox regression analysis showed that rivastigmine was associated with a statistically significant reduction in the prescription of antipsychotic drugs relative to donepezil (hazard ratio 0.73; p = 0.044). Older age, longer time between Alzheimer's disease diagnosis and first ChEI dispensing, lower dose of ChEI at treatment initiation and the presence of baseline depression and neuropsychiatric symptoms were associated with a significantly increased likelihood of antipsychotic drug use.
In this retrospective analysis, Alzheimer's disease patients with no prior use of antipsychotics initiated on rivastigmine had a significantly lower rate of prescription of antipsychotic drugs than those treated with donepezil.
卡巴拉汀和多奈哌齐是两种乙酰胆碱酯酶抑制剂（AChEIs），用于治疗轻度至中度阿尔茨海默病。与痴呆相关的行为问题通常通过环境改变和使用精神药物（包括抗精神病药物）来管理。然而，AChEIs 也与阿尔茨海默病患者行为症状的减少有关。这项回顾性、平行队列、产生假说的研究调查了与多奈哌齐相比，使用卡巴拉汀治疗是否与减少抗精神病药物处方有关。
对两个索赔数据库进行了合并分析。如果患者有阿尔茨海默病的诊断并且新开始使用卡巴拉汀或多奈哌齐，则将其纳入研究。排除了之前使用美金刚和/或抗精神病药物的患者。进行 Kaplan-Meier 和 Cox 分析以比较卡巴拉汀组和多奈哌齐组之间抗精神病药物使用的比率。
共有 956 名接受卡巴拉汀和 12778 名接受多奈哌齐的患者构成了研究人群。分析表明，64 名（6.7%）卡巴拉汀和 989 名（7.7%）多奈哌齐患者接受了抗精神病药物治疗（来自 Kaplan-Meier 分析的对数秩检验，p=0.2289）。Cox 回归分析显示，与多奈哌齐相比，卡巴拉汀与抗精神病药物处方的统计学显著减少相关（风险比 0.73；p=0.044）。年龄较大、阿尔茨海默病诊断和首次 AChEI 配药之间的时间较长、治疗开始时 AChEI 剂量较低以及存在基线抑郁和神经精神症状与抗精神病药物使用的可能性显著增加相关。
在这项回顾性分析中，没有使用过抗精神病药物的新开始使用卡巴拉汀的阿尔茨海默病患者的抗精神病药物处方率明显低于接受多奈哌齐治疗的患者。
