Wurm Raphael, Stamm Tanja, Reichardt Berthold, Schwarz Felix, Parvizi Tandis, Silvaieh Sara, König Theresa, Cetin Hakan, Stögmann Elisabeth
Department of Neurology Medical University of Vienna Vienna Austria.
Center for Medical Statistics, Informatics and Intelligent Systems Medical University of Vienna Vienna Austria.
Alzheimers Dement (N Y). 2020 Apr 29;6(1):e12014. doi: 10.1002/trc2.12014. eCollection 2020.
Dementia is a leading and growing cause of morbidity and mortality. The aim of this study was to investigate real-world prescription patterns of antidementive medication in one of the largest cohorts published thus far to optimize use in this growing population.
Prescription claims from 2005 to 2016 were provided by Austrian sickness funds, covering 98% of the population of Austria. Patients treated with at least one of the four approved antidementive drugs (ADDs) were included. Prescription prevalence was calculated for 2014 and 2015, and prescription patterns were traced on an individual level during the entire study period.
A total of 127,896 patients were treated with an ADD between 2005 and 2016. The prevalence was 0.93% in 2014 and 1% in 2015. The median age at initiation of treatment was 82.3 years, and 65% were female. Initial therapy was a cholinesterase inhibitor (ChEI) in 80% and memantine in 20%. The median duration of therapy was 13.3 months. Eighteen percent of patients switched medication: two thirds to receive memantine, and one third to a different cholinesterase inhibitor. More than 26% discontinued treatment early.
We find that discontinuation of ADDs is more frequent than switching; memantine is a common starting drug and age at the start of treatment is rather high in this population. Interpretation should be cautious, but the data may suggest that treatment guidelines are followed inconsistently. Appropriate provision of the available options should be emphasized to optimize cognitive survival, comorbidity, quality of life, and health care expenditures.
痴呆症是发病率和死亡率的主要且不断上升的原因。本研究的目的是调查迄今为止发表的最大队列之一中抗痴呆药物的实际处方模式，以优化在这一不断增长的人群中的使用。
奥地利疾病基金提供了2005年至2016年的处方数据，覆盖奥地利98%的人口。纳入至少接受过四种获批抗痴呆药物（ADDs）之一治疗的患者。计算了2014年和2015年的处方患病率，并在整个研究期间追踪个体层面的处方模式。
2005年至2016年期间，共有127,896名患者接受了ADD治疗。2014年的患病率为0.93%，2015年为1%。开始治疗的中位年龄为82.3岁，65%为女性。初始治疗中80%为胆碱酯酶抑制剂（ChEI），20%为美金刚。治疗的中位持续时间为13.3个月。18%的患者更换了药物：三分之二换成美金刚，三分之一换成另一种胆碱酯酶抑制剂。超过26%的患者提前停药。
我们发现ADD停药比换药更频繁；美金刚是常见的起始药物，该人群开始治疗的年龄相当高。解释时应谨慎，但数据可能表明治疗指南的遵循情况不一致。应强调适当提供可用的选择，以优化认知生存、合并症、生活质量和医疗保健支出。
