Guba-Menzel Miriam, Hussenoeder Felix S, Kostev Karel
Epidemiology, IQVIA, Frankfurt am Main, Germany.
Faculty of Medicine, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
J Alzheimers Dis Rep. 2025 Sep 5;9:25424823251372924. doi: 10.1177/25424823251372924. eCollection 2025 Jan-Dec.
Despite the availability of these therapies, maintaining long-term adherence remains a significant challenge.
This retrospective cohort study aimed to investigate 12-month and 5-year persistence with antidementia drug therapy in Germany and to examine the association between demographic and clinical variables and the risk of therapy discontinuation.
Patients aged 60 years or older from the IQVIA Longitudinal Prescription Database who received an initial prescription for antidementia therapy between 2016 and 2023 (index date) were included. Time to discontinuation was estimated using the Kaplan-Meier method, and a multivariable Cox proportional hazards model was used to assess associations between predefined variables and the risk of discontinuation.
The study included 567,815 patients (mean age: 80.2 years, 59.1% female). Five years after the index date, 19.8% of dementia patients were still receiving therapy, with a 12-month persistence rate of 53.1%. Cox regression models conducted for the total population revealed that younger age (<70 versus ≥90 years; HR: 1.21; 95% CI: 1.19-1.23; 71-80 years versus ≥90 years; HR: 1.13; 95% CI: 1.11-1.14) was significantly associated with an increased risk of therapy discontinuation. Initiating therapy with memantine was associated with a slightly lower risk of discontinuation compared to donepezil (HR: 0.87; 95% CI: 0.86-0.87).
In this study, half of the patients discontinued antidementia therapy within one year and 80% within five years. Younger age was linked to a higher risk of therapy discontinuation, while memantine therapy was associated with improved persistence, potentially reflecting better adherence among patients with more advanced dementia.
尽管有这些治疗方法，但保持长期依从性仍然是一项重大挑战。
这项回顾性队列研究旨在调查德国抗痴呆药物治疗的12个月和5年持续率，并研究人口统计学和临床变量与治疗中断风险之间的关联。
纳入了来自IQVIA纵向处方数据库的60岁及以上患者，这些患者在2016年至2023年（索引日期）期间接受了抗痴呆治疗初始处方。使用Kaplan-Meier方法估计停药时间，并使用多变量Cox比例风险模型评估预定义变量与停药风险之间的关联。
该研究纳入了567,815名患者（平均年龄：80.2岁，59.1%为女性）。索引日期后五年，19.8%的痴呆患者仍在接受治疗，12个月持续率为53.1%。对总体人群进行的Cox回归模型显示，年龄较小（<70岁与≥90岁相比；风险比：1.21；95%置信区间：1.19-1.23；71-80岁与≥90岁相比；风险比：1.13；95%置信区间：1.11-1.14）与治疗中断风险增加显著相关。与多奈哌齐相比，使用美金刚开始治疗的停药风险略低（风险比：0.87；95%置信区间：0.86-0.87）。
在本研究中，一半的患者在一年内停用抗痴呆治疗，80%在五年内停用。年龄较小与治疗中断风险较高相关，而美金刚治疗与更好的持续率相关，这可能反映了痴呆程度较重患者的依从性更好。
