Lee Eunyoung, Kang Sungwoo, Ye Byoung Seok, Lee Young-Gun
Division of Infectious Diseases, Boramae Medical Center, Seoul, Korea.
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2025 Sep 8;40(35):e226. doi: 10.3346/jkms.2025.40.e226.
Readily available treatments for Alzheimer's disease and related dementia (ADRD) include acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists. Non-adherence and early discontinuation of anti-dementia medications are prevalent issues. We aimed to investigate factors associated with suboptimal usage of anti-dementia medications in ADRD.
Based on data extracted from a claim database in South Korea, 508,958 patients with ADRD who began taking anti-dementia medication between 2018 and 2020 were included. The mean possession ratio is the ratio of the sum of prescribed medication supply over one year and non-adherence is defined as mean possession ratio < 80%. Discontinuation is defined as no prescription of anti-dementia medications, or no switch to other anti-dementia medications, within 45 days after the run-out date. The cumulative incidence of discontinuation of anti-dementia medication was estimated using the Kaplan-Meier method. Factors associated with non-adherence were evaluated using logistic regression analyses.
Within the first year, the non-adherence ratio was 40.8%, while the discontinuation ratio was 43.6%, and approximately 30% of patients discontinued medication within 90 days after initiation. Younger age at diagnosis, female sex, and prescription at non-tertiary hospitals or clinics other than neurology/psychiatry were associated with increased risk of non-adherence. Compared with Seoul, a prescription issued by neurology/psychiatry departments at a tertiary hospital in other provinces was associated with a 75% higher risk of non-adherence.
Strategies targeting non-adherence are warranted to minimize disparities in the management of patients with dementia.
阿尔茨海默病及相关痴呆症（ADRD）的现有治疗方法包括乙酰胆碱酯酶抑制剂和N-甲基-D-天冬氨酸受体拮抗剂。抗痴呆药物的不依从和早期停药是普遍存在的问题。我们旨在调查与ADRD中抗痴呆药物使用不当相关的因素。
基于从韩国索赔数据库中提取的数据，纳入了2018年至2020年间开始服用抗痴呆药物的508958例ADRD患者。平均持有率是一年中处方药物供应量总和的比率，不依从定义为平均持有率<80%。停药定义为在耗尽日期后45天内未开具抗痴呆药物处方，或未换用其他抗痴呆药物。使用Kaplan-Meier方法估计抗痴呆药物停药的累积发生率。使用逻辑回归分析评估与不依从相关的因素。
在第一年，不依从率为40.8%，停药率为43.6%，约30%的患者在开始用药后90天内停药。诊断时年龄较小、女性以及在非三级医院或非神经科/精神科诊所开出处方与不依从风险增加相关。与首尔相比，其他省份三级医院神经科/精神科开具的处方与不依从风险高75%相关。
有必要采取针对不依从的策略，以尽量减少痴呆患者管理中的差异。
