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Efficacy of rivastigmine in subjects with moderately severe Alzheimer's disease.
Int J Geriatr Psychiatry. 2004 Mar; 19(3):243-9.IJ

Abstract

BACKGROUND

Cholinesterase (ChE) inhibitors are primarily used in the treatment of mild to moderate Alzheimer's disease (AD), but may also be effective in more severe disease.

OBJECTIVE

To evaluate the dual ChE inhibitor, rivastigmine, in more severe dementia.

METHODS

We retrospectively analysed pooled data from three randomised, placebo-controlled, double-blind, 6-month trials, involving 2126 AD subjects. Subjects were selected according to baseline Mini-Mental State Examination (MMSE) score to identify subjects with more severe cognitive impairment (10-12 MMSE points). One-hundred-and-seventeen subjects were included who had been treated with rivastigmine 6-12 mg/day or placebo. The AD Assessment Scale-Cognitive Subscale (ADAS-Cog), the MMSE, a six-item subscore of the Progressive Deterioration Scale (PDS) and the BEHAVE-AD assessed efficacy. Tolerability was assessed by recording adverse events (AEs) and the relative risk (RR) of discontinuation.

RESULTS

This group of subjects responded well to rivastigmine. After 6 months, the mean ADAS-Cog score declined by 6.3 points in the placebo group and increased by 0.2 points in the rivastigmine group (observed cases; p<0.001). Clinical benefits were also observed with the MMSE, the six-item PDS score and items of the BEHAVE-AD. Rivastigmine showed the same pattern of AEs as in other studies, but the RR of dropping out due to AEs was lower than in subjects with milder AD.

CONCLUSION

Current treatment guidelines do not recommend treating individuals with severe AD with ChE inhibitors. However, this retrospective analysis suggests that rivastigmine 6-12 mg/day may benefit subjects with more severe disease, as well as subjects with mild to moderate impairment.

Authors+Show Affiliations

University of Manchester, Wythenshawe Hospital, Manchester, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15027039

Citation

Burns, A, et al. "Efficacy of Rivastigmine in Subjects With Moderately Severe Alzheimer's Disease." International Journal of Geriatric Psychiatry, vol. 19, no. 3, 2004, pp. 243-9.
Burns A, Spiegel R, Quarg P. Efficacy of rivastigmine in subjects with moderately severe Alzheimer's disease. Int J Geriatr Psychiatry. 2004;19(3):243-9.
Burns, A., Spiegel, R., & Quarg, P. (2004). Efficacy of rivastigmine in subjects with moderately severe Alzheimer's disease. International Journal of Geriatric Psychiatry, 19(3), 243-9.
Burns A, Spiegel R, Quarg P. Efficacy of Rivastigmine in Subjects With Moderately Severe Alzheimer's Disease. Int J Geriatr Psychiatry. 2004;19(3):243-9. PubMed PMID: 15027039.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of rivastigmine in subjects with moderately severe Alzheimer's disease. AU - Burns,A, AU - Spiegel,R, AU - Quarg,P, PY - 2004/3/18/pubmed PY - 2004/4/14/medline PY - 2004/3/18/entrez SP - 243 EP - 9 JF - International journal of geriatric psychiatry JO - Int J Geriatr Psychiatry VL - 19 IS - 3 N2 - BACKGROUND: Cholinesterase (ChE) inhibitors are primarily used in the treatment of mild to moderate Alzheimer's disease (AD), but may also be effective in more severe disease. OBJECTIVE: To evaluate the dual ChE inhibitor, rivastigmine, in more severe dementia. METHODS: We retrospectively analysed pooled data from three randomised, placebo-controlled, double-blind, 6-month trials, involving 2126 AD subjects. Subjects were selected according to baseline Mini-Mental State Examination (MMSE) score to identify subjects with more severe cognitive impairment (10-12 MMSE points). One-hundred-and-seventeen subjects were included who had been treated with rivastigmine 6-12 mg/day or placebo. The AD Assessment Scale-Cognitive Subscale (ADAS-Cog), the MMSE, a six-item subscore of the Progressive Deterioration Scale (PDS) and the BEHAVE-AD assessed efficacy. Tolerability was assessed by recording adverse events (AEs) and the relative risk (RR) of discontinuation. RESULTS: This group of subjects responded well to rivastigmine. After 6 months, the mean ADAS-Cog score declined by 6.3 points in the placebo group and increased by 0.2 points in the rivastigmine group (observed cases; p<0.001). Clinical benefits were also observed with the MMSE, the six-item PDS score and items of the BEHAVE-AD. Rivastigmine showed the same pattern of AEs as in other studies, but the RR of dropping out due to AEs was lower than in subjects with milder AD. CONCLUSION: Current treatment guidelines do not recommend treating individuals with severe AD with ChE inhibitors. However, this retrospective analysis suggests that rivastigmine 6-12 mg/day may benefit subjects with more severe disease, as well as subjects with mild to moderate impairment. SN - 0885-6230 UR - https://www.unboundmedicine.com/medline/citation/15027039/Efficacy_of_rivastigmine_in_subjects_with_moderately_severe_Alzheimer's_disease_ L2 - https://doi.org/10.1002/gps.1058 DB - PRIME DP - Unbound Medicine ER -