Heo Rachel J, Negida Ahmed, Wyman-Chick Kathryn A, Bateman James R, Rodriguez-Porcel Federico, Berman Brian D, Mukhopadhyay Nitai, Barrett Matthew J
Department of Neurology Virginia Commonwealth University Richmond Virginia USA.
HealthPartners Struthers Parkinson's Center Golden Valley Minnesota USA.
Alzheimers Dement (N Y). 2025 Jul 19;11(3):e70136. doi: 10.1002/trc2.70136. eCollection 2025 Jul-Sep.
Current evidence supports the use of cholinesterase inhibitors (ChEIs) as the first-line symptomatic treatment for improving cognition in dementia with Lewy bodies (DLB). Little is known about current prescribing patterns of ChEIs in DLB. This study aimed to identify the patterns and predictors of ChEI prescribing in patients with DLB in the United States.
Using the TriNetX database, we identified 20,643 US patients ages 45 to 90 who were diagnosed with DLB between 2004 and 2024. We only included those with more than one documented diagnosis. Prescription data and patterns for donepezil, rivastigmine, galantamine, and memantine were analyzed. We used multivariate logistic regression models to estimate the odds of ChEI prescription based on demographic factors.
We found that 51.9% of DLB patients were ever prescribed a ChEI, and those who were prescribed a ChEI had a greater diagnosis interval. Patients who were prescribed ChEIs were more likely to be Hispanic (odds ratio [OR] 1.36, 95% confidence interval [CI]: 1.15, 1.59) and reside in the Midwest (OR 1.93, 95% CI: 1.76, 2.13), while Black patients were less likely to be prescribed ChEIs (OR 0.80, 95% CI: 0.71, 0.91). Of patients prescribed ChEIs, the median time between the first and last prescription was 13.4 months (interquartile range: 1.1, 32.9), and donepezil was the most commonly prescribed (76.9%) followed by rivastigmine (35.6%) and galantamine (3.9%). Over the 20-year study period, there was a gradual increase in the rate of prescribing of ChEIs, and the prescribing frequency of individual ChEIs remained relatively stable.
Despite evidence supporting their tolerability and efficacy, ChEIs are under-prescribed in DLB patients within the United States, and there are differences in prescribing based on race, ethnicity, and region. There is a need to understand the reasons for under-prescribing ChEIs in DLB, so interventions focused on increasing use can be developed.
Despite proven tolerability and efficacy, cholinesterase inhibitors (ChEIs) are under-prescribed in dementia with Lewy bodies (DLB).Race, ethnicity, and region significantly affected the odds of ChEI prescription.There is a need to increase ChEI prescribing for DLB patients.
目前的证据支持使用胆碱酯酶抑制剂（ChEIs）作为改善路易体痴呆（DLB）认知功能的一线对症治疗药物。目前对于DLB患者中ChEIs的处方模式了解甚少。本研究旨在确定美国DLB患者中ChEIs的处方模式及预测因素。
利用TriNetX数据库，我们识别出20643名年龄在45至90岁之间、于2004年至2024年期间被诊断为DLB的美国患者。我们仅纳入那些有不止一次记录诊断的患者。对多奈哌齐、卡巴拉汀、加兰他敏和美金刚的处方数据及模式进行了分析。我们使用多变量逻辑回归模型根据人口统计学因素估计ChEIs处方的几率。
我们发现51.9%的DLB患者曾被开具ChEIs处方，且被开具ChEIs处方的患者诊断间隔更长。被开具ChEIs处方的患者更可能是西班牙裔（优势比[OR]1.36，95%置信区间[CI]：1.15，1.59）且居住在中西部地区（OR 1.93，95% CI：1.76，2.13），而黑人患者被开具ChEIs处方的可能性较小（OR 0.80，95% CI：0.71，0.91）。在被开具ChEIs处方的患者中，首次与末次处方之间的中位时间为13.4个月（四分位间距：1.1，32.9），多奈哌齐是最常被开具的药物（76.9%），其次是卡巴拉汀（35.6%）和加兰他敏（3.9%）。在20年的研究期间，ChEIs的处方率逐渐上升，且各ChEIs的处方频率保持相对稳定。
尽管有证据支持其耐受性和疗效，但在美国，DLB患者中ChEIs的处方量不足，且在处方方面存在基于种族、民族和地区的差异。有必要了解DLB患者中ChEIs处方量不足的原因，以便制定旨在增加其使用的干预措施。
尽管胆碱酯酶抑制剂（ChEIs）已被证明具有耐受性和疗效，但在路易体痴呆（DLB）中其处方量不足。种族、民族和地区显著影响ChEIs处方的几率。有必要增加DLB患者的ChEIs处方量。
