Laboratory for Quality Assessment of Geriatric Therapies and Services, Mario Negri Institute for Pharmacological Research, Milan, Italy.
Pharmacoepidemiol Drug Saf. 2011 May;20(5):497-505. doi: 10.1002/pds.2124.
This study was designed to examine the prevalence of cholinesterase inhibitor (ChEI) use and the proportions of patients treated with ChEIs by using an administrative prescription database of prevalent and incident cases of mild to moderate Alzheimer's disease (AD) in relation to age and duration of therapy.
A prospective observational study covering individuals aged 65 years or older who received at least one prescription of ChEIs between 1 January 2002 and 31 December 2007 was conducted in three health administrative areas in the Lombardy Region, Italy.
The prevalence of those who received at least one prescription for ChEIs rose from 0.5% in 2002 to 0.7% in 2004, reaching a plateau. Among estimated prevalent cases of mild to moderate AD, the prevalence of patients who received at least one prescription of ChEIs varied in different age groups, rising in those over 80 years and falling slightly in those under 80 years, particularly in patients aged 65-69 years (test for trend, p < 0.001). Among estimated incident cases, the percentage of newly treated patients dropped from 12% in 2004 to 8% in 2007, as well as within each age group (test for trend, p < 0.001). In the cohort of incident users, nearly 40% of patients who started treatment in 2004 were still in treatment 3 years later.
The prescription prevalence of ChEIs increased up to 2004, then reached a plateau. This might reflect the practical response of physicians and patients to the controversy and uncertainty surrounding the clinical value of these expensive drugs for the treatment of AD.
本研究旨在通过使用轻度至中度阿尔茨海默病（AD）现患和新发病例的行政处方数据库，检查胆碱酯酶抑制剂（ChEI）的使用流行率以及用 ChEI 治疗的患者比例，同时考虑年龄和治疗持续时间。
在意大利伦巴第地区的三个卫生行政区域内，进行了一项前瞻性观察研究，覆盖年龄在 65 岁及以上且在 2002 年 1 月 1 日至 2007 年 12 月 31 日期间至少接受过一次 ChEI 处方的个体。
至少接受过一次 ChEI 处方的患者的流行率从 2002 年的 0.5%上升到 2004 年的 0.7%，达到了一个平台期。在估计的轻度至中度 AD 现患病例中，接受至少一次 ChEI 处方的患者的流行率在不同年龄组中有所不同，在 80 岁以上的患者中上升，在 80 岁以下的患者中略有下降，特别是在 65-69 岁的患者中（趋势检验，p<0.001）。在估计的新发病例中，新治疗患者的比例从 2004 年的 12%下降到 2007 年的 8%，且在每个年龄组中均下降（趋势检验，p<0.001）。在新发使用者队列中，2004 年开始治疗的患者中有近 40%在 3 年后仍在接受治疗。
ChEI 的处方流行率在 2004 年之前增加，之后达到了一个平台期。这可能反映了医生和患者对这些昂贵药物治疗 AD 的临床价值的争议和不确定性的实际反应。
