Tags

Type your tag names separated by a space and hit enter

DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT.

Abstract

BACKGROUND

Alzheimer's disease (AD) is the commonest cause of dementia. Cholinesterase inhibitors, such as donepezil, are the drug class with the best evidence of efficacy, licensed for mild to moderate AD, while the glutamate antagonist memantine has been widely prescribed, often in the later stages of AD. Memantine is licensed for moderate to severe dementia in AD but is not recommended by the England and Wales National Institute for Health and Clinical Excellence. However, there is little evidence to guide clinicians as to what to prescribe as AD advances; in particular, what to do as the condition progresses from moderate to severe. Options include continuing cholinesterase inhibitors irrespective of decline, adding memantine to cholinesterase inhibitors, or prescribing memantine instead of cholinesterase inhibitors. The aim of this trial is to establish the most effective drug option for people with AD who are progressing from moderate to severe dementia despite treatment with donepezil.

METHOD

DOMINO-AD is a pragmatic, 15 centre, double-blind, randomized, placebo controlled trial. Patients with AD, currently living at home, receiving donepezil 10 mg daily, and with Standardized Mini-Mental State Examination (SMMSE) scores between 5 and 13 are being recruited. Each is randomized to one of four treatment options: continuation of donepezil with memantine placebo added; switch to memantine with donepezil placebo added; donepezil and memantine together; or donepezil placebo with memantine placebo. 800 participants are being recruited and treatment continues for one year. Primary outcome measures are cognition (SMMSE) and activities of daily living (Bristol Activities of Daily Living Scale). Secondary outcomes are non-cognitive dementia symptoms (Neuropsychiatric Inventory), health related quality of life (EQ-5D and DEMQOL-proxy), carer burden (General Health Questionnaire-12), cost effectiveness (using Client Service Receipt Inventory) and institutionalization. These outcomes are assessed at baseline, 6, 18, 30 and 52 weeks. All participants will be subsequently followed for 3 years by telephone interview to record institutionalization.

DISCUSSION

There is considerable debate about the clinical and cost effectiveness of anti-dementia drugs. DOMINO-AD seeks to provide clear evidence on the best treatment strategies for those managing patients at a particularly important clinical transition point.

TRIAL REGISTRATION

Current controlled trials ISRCTN49545035.

Links

  • PMC Free PDF
  • PMC Free Full Text
  • FREE Publisher Full Text
  • Authors+Show Affiliations

    ,

    Section of Old Age Psychiatry, The University of Nottingham, A Floor, South Block, Queen's Medical Centre, Nottingham NG7 2UH, UK. rob.jones@nottingham.ac.uk

    , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

    Source

    Trials 10: 2009 Jul 24 pg 57

    MeSH

    Alzheimer Disease
    Donepezil
    Dopamine Agents
    Evidence-Based Medicine
    Humans
    Indans
    Memantine
    Nootropic Agents
    Piperidines
    Research Design
    Severity of Illness Index

    Pub Type(s)

    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    19630974

    Citation

    Jones, Rob, et al. "DOMINO-AD Protocol: Donepezil and Memantine in Moderate to Severe Alzheimer's Disease - a Multicentre RCT." Trials, vol. 10, 2009, p. 57.
    Jones R, Sheehan B, Phillips P, et al. DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT. Trials. 2009;10:57.
    Jones, R., Sheehan, B., Phillips, P., Juszczak, E., Adams, J., Baldwin, A., ... Howard, R. (2009). DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT. Trials, 10, p. 57. doi:10.1186/1745-6215-10-57.
    Jones R, et al. DOMINO-AD Protocol: Donepezil and Memantine in Moderate to Severe Alzheimer's Disease - a Multicentre RCT. Trials. 2009 Jul 24;10:57. PubMed PMID: 19630974.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT. AU - Jones,Rob, AU - Sheehan,Bart, AU - Phillips,Patrick, AU - Juszczak,Ed, AU - Adams,Jessica, AU - Baldwin,Ashley, AU - Ballard,Clive, AU - Banerjee,Sube, AU - Barber,Bob, AU - Bentham,Peter, AU - Brown,Richard, AU - Burns,Alistair, AU - Dening,Tom, AU - Findlay,David, AU - Gray,Richard, AU - Griffin,Mary, AU - Holmes,Clive, AU - Hughes,Alan, AU - Jacoby,Robin, AU - Johnson,Tony, AU - Jones,Roy, AU - Knapp,Martin, AU - Lindesay,James, AU - McKeith,Ian, AU - McShane,Rupert, AU - Macharouthu,Ajay, AU - O'Brien,John, AU - Onions,Caroline, AU - Passmore,Peter, AU - Raftery,James, AU - Ritchie,Craig, AU - Howard,Rob, AU - ,, Y1 - 2009/07/24/ PY - 2009/04/19/received PY - 2009/07/24/accepted PY - 2009/7/28/entrez PY - 2009/7/28/pubmed PY - 2009/9/19/medline SP - 57 EP - 57 JF - Trials JO - Trials VL - 10 N2 - BACKGROUND: Alzheimer's disease (AD) is the commonest cause of dementia. Cholinesterase inhibitors, such as donepezil, are the drug class with the best evidence of efficacy, licensed for mild to moderate AD, while the glutamate antagonist memantine has been widely prescribed, often in the later stages of AD. Memantine is licensed for moderate to severe dementia in AD but is not recommended by the England and Wales National Institute for Health and Clinical Excellence. However, there is little evidence to guide clinicians as to what to prescribe as AD advances; in particular, what to do as the condition progresses from moderate to severe. Options include continuing cholinesterase inhibitors irrespective of decline, adding memantine to cholinesterase inhibitors, or prescribing memantine instead of cholinesterase inhibitors. The aim of this trial is to establish the most effective drug option for people with AD who are progressing from moderate to severe dementia despite treatment with donepezil. METHOD: DOMINO-AD is a pragmatic, 15 centre, double-blind, randomized, placebo controlled trial. Patients with AD, currently living at home, receiving donepezil 10 mg daily, and with Standardized Mini-Mental State Examination (SMMSE) scores between 5 and 13 are being recruited. Each is randomized to one of four treatment options: continuation of donepezil with memantine placebo added; switch to memantine with donepezil placebo added; donepezil and memantine together; or donepezil placebo with memantine placebo. 800 participants are being recruited and treatment continues for one year. Primary outcome measures are cognition (SMMSE) and activities of daily living (Bristol Activities of Daily Living Scale). Secondary outcomes are non-cognitive dementia symptoms (Neuropsychiatric Inventory), health related quality of life (EQ-5D and DEMQOL-proxy), carer burden (General Health Questionnaire-12), cost effectiveness (using Client Service Receipt Inventory) and institutionalization. These outcomes are assessed at baseline, 6, 18, 30 and 52 weeks. All participants will be subsequently followed for 3 years by telephone interview to record institutionalization. DISCUSSION: There is considerable debate about the clinical and cost effectiveness of anti-dementia drugs. DOMINO-AD seeks to provide clear evidence on the best treatment strategies for those managing patients at a particularly important clinical transition point. TRIAL REGISTRATION: Current controlled trials ISRCTN49545035. SN - 1745-6215 UR - https://www.unboundmedicine.com/medline/citation/19630974/DOMINO_AD_protocol:_donepezil_and_memantine_in_moderate_to_severe_Alzheimer's_disease___a_multicentre_RCT_ L2 - https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-10-57 DB - PRIME DP - Unbound Medicine ER -