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Effects of donepezil, galantamine and rivastigmine in 938 Italian patients with Alzheimer's disease: a prospective, observational study.

Abstract

Acetylcholinesterase inhibitors (AChEIs) have been used to improve cognitive status and disability in patients with mild to moderate Alzheimer's disease (AD). However, while the efficacy of AChEIs (i.e. how they act in randomized controlled trials) in this setting is widely accepted, their effectiveness (i.e. how they behave in the real world) remains controversial. To compare the effects of three AChEIs, donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon), in an Italian national, prospective, observational study representative of the 'real world' clinical practice of AChEI treatment for AD. 938 patients with mild to moderate AD collected within the framework of the Italian National Cronos Project (CP), involving several UVAs (AD Evaluation Units) spread over the entire national territory, who were receiving donepezil, galantamine or rivastigmine were followed for 36 weeks by measuring: (i) function, as determined by the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales; (ii) cognition, as measured by the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) [primary outcome measures]; and (iii) behaviour, as measured on the Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR) scale. Moreover, all patients were genotyped for apolipoprotein E (apoE) genetic variants. No statistically significant improvement in the primary outcome measures (MMSE and ADAS-Cog) was observed with drug therapy at 36 weeks, at which point all groups had lost, on average, 1 point on the MMSE and gained 2-3 points on the ADAS-Cog scale compared with baseline. On the secondary outcome measures at week 36, all treatment groups showed a significant worsening on the ADL and IADL scales compared with baseline, while on the NPI scale there were no significant differences from baseline except for the galantamine-treated group which worsened significantly. Moreover, patients receiving galantamine worsened significantly compared with the donepezil-treated group on the IADL scale. ApoE epsilon4 allele did not influence the effect of drug therapy. Over a 36-week follow-up period, no significant difference in the effects of donepezil, galantamine and rivastigmine on a variety of functional and cognitive parameters was observed in a large number of apoE-genotyped patients with mild to moderate AD recruited within the framework of a national project representative of the scenario usually encountered in actual clinical practice in Italy. The limitations (possibility of administration of lower drug doses than are used in clinical trials, relatively short follow-up period and the lack of randomization) and strengths (large number of patients, concomitant observation of the three drugs and the number of parameters assessed, including apoE genotype) of the present study are acknowledged. Our type of naturalistic study should complement clinical trials because 'real world' practice operates in the face of the numerous variables (e.g. health status and co-morbidities) associated with a complex disease such as AD in elderly people.

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  • Authors+Show Affiliations

    ,

    Department of Experimental Pathology, University of Bologna, Via S. Giacomo 12, Bologna, Italy. aurelia.santoro@unibo.it

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

    Source

    CNS drugs 24:2 2010 Feb pg 163-76

    MeSH

    Activities of Daily Living
    Aged
    Alzheimer Disease
    Apolipoproteins E
    Cholinesterase Inhibitors
    Cognition
    Donepezil
    Female
    Galantamine
    Genetic Variation
    Genotype
    Humans
    Indans
    Italy
    Male
    Outcome Assessment (Health Care)
    Phenylcarbamates
    Piperidines
    Prospective Studies
    Psychiatric Status Rating Scales
    Rivastigmine
    Severity of Illness Index
    Time Factors
    Treatment Outcome

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    20088621

    Citation

    Santoro, Aurelia, et al. "Effects of Donepezil, Galantamine and Rivastigmine in 938 Italian Patients With Alzheimer's Disease: a Prospective, Observational Study." CNS Drugs, vol. 24, no. 2, 2010, pp. 163-76.
    Santoro A, Siviero P, Minicuci N, et al. Effects of donepezil, galantamine and rivastigmine in 938 Italian patients with Alzheimer's disease: a prospective, observational study. CNS Drugs. 2010;24(2):163-76.
    Santoro, A., Siviero, P., Minicuci, N., Bellavista, E., Mishto, M., Olivieri, F., ... Franceschi, C. (2010). Effects of donepezil, galantamine and rivastigmine in 938 Italian patients with Alzheimer's disease: a prospective, observational study. CNS Drugs, 24(2), pp. 163-76. doi:10.2165/11310960-000000000-00000.
    Santoro A, et al. Effects of Donepezil, Galantamine and Rivastigmine in 938 Italian Patients With Alzheimer's Disease: a Prospective, Observational Study. CNS Drugs. 2010;24(2):163-76. PubMed PMID: 20088621.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Effects of donepezil, galantamine and rivastigmine in 938 Italian patients with Alzheimer's disease: a prospective, observational study. AU - Santoro,Aurelia, AU - Siviero,Paola, AU - Minicuci,Nadia, AU - Bellavista,Elena, AU - Mishto,Michele, AU - Olivieri,Fabiola, AU - Marchegiani,Francesca, AU - Chiamenti,Andrea Maria, AU - Benussi,Luisa, AU - Ghidoni,Roberta, AU - Nacmias,Benedetta, AU - Bagnoli,Silvia, AU - Ginestroni,Andrea, AU - Scarpino,Osvaldo, AU - Feraco,Emidio, AU - Gianni,Walter, AU - Cruciani,Guido, AU - Paganelli,Roberto, AU - Di Iorio,Angelo, AU - Scognamiglio,Mario, AU - Grimaldi,Luigi Maria Edoardo, AU - Gabelli,Carlo, AU - Sorbi,Sandro, AU - Binetti,Giuliano, AU - Crepaldi,Gaetano, AU - Franceschi,Claudio, PY - 2010/1/22/entrez PY - 2010/1/22/pubmed PY - 2010/3/17/medline SP - 163 EP - 76 JF - CNS drugs JO - CNS Drugs VL - 24 IS - 2 N2 - Acetylcholinesterase inhibitors (AChEIs) have been used to improve cognitive status and disability in patients with mild to moderate Alzheimer's disease (AD). However, while the efficacy of AChEIs (i.e. how they act in randomized controlled trials) in this setting is widely accepted, their effectiveness (i.e. how they behave in the real world) remains controversial. To compare the effects of three AChEIs, donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon), in an Italian national, prospective, observational study representative of the 'real world' clinical practice of AChEI treatment for AD. 938 patients with mild to moderate AD collected within the framework of the Italian National Cronos Project (CP), involving several UVAs (AD Evaluation Units) spread over the entire national territory, who were receiving donepezil, galantamine or rivastigmine were followed for 36 weeks by measuring: (i) function, as determined by the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales; (ii) cognition, as measured by the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) [primary outcome measures]; and (iii) behaviour, as measured on the Neuropsychiatric Inventory (NPI) and Clinical Dementia Rating (CDR) scale. Moreover, all patients were genotyped for apolipoprotein E (apoE) genetic variants. No statistically significant improvement in the primary outcome measures (MMSE and ADAS-Cog) was observed with drug therapy at 36 weeks, at which point all groups had lost, on average, 1 point on the MMSE and gained 2-3 points on the ADAS-Cog scale compared with baseline. On the secondary outcome measures at week 36, all treatment groups showed a significant worsening on the ADL and IADL scales compared with baseline, while on the NPI scale there were no significant differences from baseline except for the galantamine-treated group which worsened significantly. Moreover, patients receiving galantamine worsened significantly compared with the donepezil-treated group on the IADL scale. ApoE epsilon4 allele did not influence the effect of drug therapy. Over a 36-week follow-up period, no significant difference in the effects of donepezil, galantamine and rivastigmine on a variety of functional and cognitive parameters was observed in a large number of apoE-genotyped patients with mild to moderate AD recruited within the framework of a national project representative of the scenario usually encountered in actual clinical practice in Italy. The limitations (possibility of administration of lower drug doses than are used in clinical trials, relatively short follow-up period and the lack of randomization) and strengths (large number of patients, concomitant observation of the three drugs and the number of parameters assessed, including apoE genotype) of the present study are acknowledged. Our type of naturalistic study should complement clinical trials because 'real world' practice operates in the face of the numerous variables (e.g. health status and co-morbidities) associated with a complex disease such as AD in elderly people. SN - 1179-1934 UR - https://www.unboundmedicine.com/medline/citation/20088621/Effects_of_donepezil_galantamine_and_rivastigmine_in_938_Italian_patients_with_Alzheimer's_disease:_a_prospective_observational_study_ L2 - https://dx.doi.org/10.2165/11310960-000000000-00000 DB - PRIME DP - Unbound Medicine ER -