Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Omuta Hoyouin Hospital, Fukuoka, Japan.
J Alzheimers Dis. 2022;90(3):1177-1186. doi: 10.3233/JAD-220200.
Donepezil is frequently used to treat Alzheimer's disease (AD) symptoms but is associated with early discontinuation. Determining the persistence rates of anti-dementia drug use after donepezil initiation may inform the development and improvement of treatment strategies, but there is little evidence from Japan.
To determine anti-dementia drug persistence following donepezil initiation among AD patients in Japan using insurance claims data.
Insurance claims data for AD patients with newly prescribed donepezil were obtained from 17 municipalities between April 2014 and October 2021. Anti-dementia drug persistence was defined as a gap of ≤60 days between the last donepezil prescription and a subsequent prescription of donepezil, another cholinesterase inhibitor, or memantine. Cox proportional hazards models were used to analyze the association between care needs levels and discontinuation.
We analyzed 20,474 AD patients (mean age±standard deviation: 82.2±6.3 years, women: 65.7%). The persistence rates were 89.1% at 30 days, 79.4% at 90 days, 72.6% at 180 days, 64.5% at 360 days, and 58.3% at 540 days after initiation. Among the care needs levels, the hazard ratio (95% confidence interval) for discontinuation was 1.01 (0.94-1.07) for patients with support needs, 1.12 (1.06-1.18) for patients with low long-term care needs, and 1.31 (1.21-1.40) for patients with moderate-to-high long-term care needs relative to independent patients.
Japanese AD patients demonstrated low anti-dementia drug persistence rates that were similar to those of other countries. Higher long-term care needs were associated with discontinuation. Further measures are needed to improve drug persistence in AD patients.
多奈哌齐常用于治疗阿尔茨海默病（AD）症状，但与早期停药有关。确定多奈哌齐起始后抗痴呆药物使用的持久性率可能为治疗策略的制定和改进提供信息，但来自日本的证据很少。
使用保险索赔数据确定日本 AD 患者在开始使用多奈哌齐后的抗痴呆药物持久性。
从 2014 年 4 月至 2021 年 10 月，从 17 个市町村获得了新处方多奈哌齐的 AD 患者的保险索赔数据。抗痴呆药物的持久性定义为最后一次多奈哌齐处方和随后的多奈哌齐、另一种胆碱酯酶抑制剂或美金刚的处方之间的间隔≤60 天。使用 Cox 比例风险模型分析护理需求水平与停药之间的关系。
我们分析了 20474 名 AD 患者（平均年龄±标准差：82.2±6.3 岁，女性：65.7%）。起始后 30 天、90 天、180 天、360 天和 540 天的持续率分别为 89.1%、79.4%、72.6%、64.5%和 58.3%。在护理需求水平中，有护理需求的患者停药的风险比（95%置信区间）为 1.01（0.94-1.07），低长期护理需求的患者为 1.12（1.06-1.18），中度至高度长期护理需求的患者为 1.31（1.21-1.40），而独立患者为 1.00。
日本 AD 患者的抗痴呆药物持久性率较低，与其他国家相似。较高的长期护理需求与停药有关。需要采取进一步措施提高 AD 患者的药物持久性。
