Bhattacharjee Sandipan, Patanwala Asad E, Lo-Ciganic Wei-Hsuan, Malone Daniel C, Lee Jeannie K, Knapp Shannon M, Warholak Terri, Burke William J
Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
The University of Sydney School of Pharmacy, Royal Prince Alfred Hospital, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
Alzheimers Dement (N Y). 2019 Jul 10;5:294-302. doi: 10.1016/j.trci.2019.05.005. eCollection 2019.
Identifying Alzheimer's disease (AD) pharmacologic treatment options that effectively reduce the risk of mortality and hospitalization in real-world settings is critical.
We compared donepezil, galantamine, memantine, oral rivastigmine, and transdermal rivastigmine with regard to all-cause mortality and all-cause hospitalization risk among fee-for-service Medicare beneficiaries with AD (aged ≥ 65 years) using a retrospective cohort study design. Our primary analysis was based on intention to treat (ITT), but we also present as-treated analysis.
In our final study sample (N = 21,558), significant difference in survival among index AD medication groups were observed with donepezil being associated with better survival than memantine, and oral and transdermal forms of rivastigmine for both ITT and as-treated analysis. Difference in hazards of all-cause hospitalization among index AD medication groups was observed in ITT analysis but not in as-treated analysis.
Significant differences exist in terms of mortality and hospitalization risk with different AD medication initiation in real-world setting.
确定能在现实环境中有效降低死亡率和住院风险的阿尔茨海默病（AD）药物治疗方案至关重要。
我们采用回顾性队列研究设计，比较了多奈哌齐、加兰他敏、美金刚、口服卡巴拉汀和透皮卡巴拉汀在患有AD（年龄≥65岁）的按服务收费医疗保险受益人中的全因死亡率和全因住院风险。我们的主要分析基于意向性治疗（ITT），但我们也展示了实际治疗分析结果。
在我们的最终研究样本（N = 21,558）中，观察到索引AD药物治疗组之间的生存存在显著差异，在ITT和实际治疗分析中，多奈哌齐的生存情况优于美金刚，口服和透皮形式的卡巴拉汀也是如此。在ITT分析中观察到索引AD药物治疗组之间全因住院风险的差异，但在实际治疗分析中未观察到。
在现实环境中，不同的AD药物起始治疗在死亡率和住院风险方面存在显著差异。
