Epidemiology, IQVIA, Frankfurt, Germany.
Consulting, IQVIA, Warsaw, Poland.
J Alzheimers Dis. 2019;70(3):899-905. doi: 10.3233/JAD-190508.
Previous studies have suggested that there are substantial differences between countries in terms of persistence with antidementia drugs and that the management of dementia is likely to be population-specific.
The aim of this study was to analyze the one-year persistence with donepezil, memantine, and rivastigmine in more than 66,000 elderly patients followed in Poland.
This study included patients who were prescribed donepezil, memantine, or rivastigmine for the first time in general and neuropsychiatric practices in Poland between September 2016 and December 2017 (index date; N = 66,030). The primary outcome of the study was the one-year persistence with donepezil, memantine, and rivastigmine. Non-persistence was defined as a gap of at least 90 days without anti-dementia therapy. The secondary outcome was the identification of variables significantly associated with treatment non-persistence.
After 12 months of follow-up, 42.2% of donepezil users, 46.0% of rivastigmine users, and 65.9% of memantine users were persistent (log-rank p-value <0.001). Memantine (hazard ratio [HR] = 0.58) and rivastigmine users (HR = 0.92) were less likely to discontinue treatment one year after initiation than donepezil users. Furthermore, a younger age (60-64 years: HR = 1.32; 65-74 years: HR = 1.13) and therapy initiated by a neuropsychiatrist (HR = 1.11) were positively associated with therapy discontinuation, while we observed a negative association between the prescription of anti-psychotic drugs and non-persistence (HR = 0.81).
One-year persistence with donepezil, memantine, and rivastigmine was low in elderly patients followed in Poland, and was influenced by age, physician specialty, and co-therapy.
先前的研究表明，各国在抗痴呆药物的持续使用方面存在很大差异，并且痴呆症的治疗可能具有人群特异性。
本研究旨在分析 66000 多名在波兰接受治疗的老年患者使用多奈哌齐、美金刚和利斯的明的一年持续性。
本研究纳入了 2016 年 9 月至 2017 年 12 月期间首次在波兰的普通和神经精神病学实践中开处方多奈哌齐、美金刚或利斯的明的患者（索引日期；N=66030）。该研究的主要结局是多奈哌齐、美金刚和利斯的明的一年持续性。非持续性定义为至少 90 天没有抗痴呆治疗。次要结局是确定与治疗非持续性显著相关的变量。
在 12 个月的随访后，42.2%的多奈哌齐使用者、46.0%的利斯的明使用者和 65.9%的美金刚使用者具有持续性（对数秩检验 P 值<0.001）。与多奈哌齐使用者相比，美金刚（风险比 [HR] = 0.58）和利斯的明使用者（HR = 0.92）在起始治疗一年后停止治疗的可能性较小。此外，年龄较轻（60-64 岁：HR=1.32；65-74 岁：HR=1.13）和由神经精神病学家起始治疗（HR=1.11）与治疗中断呈正相关，而我们观察到抗精神病药物的处方与非持续性之间呈负相关（HR=0.81）。
在波兰接受治疗的老年患者中，多奈哌齐、美金刚和利斯的明的一年持续性较低，且受到年龄、医生专业和联合治疗的影响。
