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Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's disease.
Pharmacoepidemiol Drug Saf. 2010 Jul; 19(7):670-9.PD

Abstract

PURPOSE

To estimate the risk (and determinants) of discontinuing cholinesterase inhibitors (ChEIs) in a population-based sample of Alzheimer's disease (AD) patients.

METHODS

This is a retrospective cohort study based on linked de-identified administrative health data from the province of Saskatchewan, Canada. The cohort included all AD patients receiving a ChEI prescription during the first year of provincial coverage (2000-2001). Persistence was defined as no gap of 60+ days between depletion and subsequent refill of a ChEI prescription. Kaplan-Meier analysis was used to estimate the risk of discontinuation over 40 months. Cox regression with time-varying covariates was used to assess risk factors for ChEI discontinuation.

RESULTS

The sample included 1080 patients (64% female, average age 80 +/- 7 years). Baseline mean (SD) Mini-Mental State Examination (MMSE) and Functional Activities Questionnaire (FAQ) scores were 20.8 (4.4) and 17.5 (7.7), respectively. Over 40 months, 84% discontinued therapy. The 1-year risk of discontinuation was 66.4% (95%CI 63.5-69.3%). Discontinuation was significantly more likely for females (adjusted HR 1.34, 95%CI 1.16-1.55) and among those with lower MMSE scores (2.52, 2.01-3.17 if <15), not receiving social assistance (1.25, 1.07-1.45), and paying at least 65% of total prescription costs (1.51, 1.30-1.74). It was significantly less likely for patients with frequent physician visits (0.78, 0.66-0.93, for 7-19 vs. <7 visits), higher Chronic Disease Scores (0.74, 0.61-0.89, for 7+ vs. <4), and FAQ scores of 9+ (0.82, 0.69-0.99).

CONCLUSION

The likelihood of discontinuing ChEI therapy was high in this real-world sample of AD patients. Significant predictors included clinical, socioeconomic, and practice factors.

Authors+Show Affiliations

Methodology Unit, Canadian Institute for Health Information, Ottawa, Ontario, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20583207

Citation

Amuah, Joseph E., et al. "Persistence With Cholinesterase Inhibitor Therapy in a Population-based Cohort of Patients With Alzheimer's Disease." Pharmacoepidemiology and Drug Safety, vol. 19, no. 7, 2010, pp. 670-9.
Amuah JE, Hogan DB, Eliasziw M, et al. Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's disease. Pharmacoepidemiol Drug Saf. 2010;19(7):670-9.
Amuah, J. E., Hogan, D. B., Eliasziw, M., Supina, A., Beck, P., Downey, W., & Maxwell, C. J. (2010). Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's disease. Pharmacoepidemiology and Drug Safety, 19(7), 670-9. https://doi.org/10.1002/pds.1946
Amuah JE, et al. Persistence With Cholinesterase Inhibitor Therapy in a Population-based Cohort of Patients With Alzheimer's Disease. Pharmacoepidemiol Drug Saf. 2010;19(7):670-9. PubMed PMID: 20583207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's disease. AU - Amuah,Joseph E, AU - Hogan,David B, AU - Eliasziw,Misha, AU - Supina,Alison, AU - Beck,Patricia, AU - Downey,Winanne, AU - Maxwell,Colleen J, PY - 2010/6/29/entrez PY - 2010/6/29/pubmed PY - 2010/10/12/medline SP - 670 EP - 9 JF - Pharmacoepidemiology and drug safety JO - Pharmacoepidemiol Drug Saf VL - 19 IS - 7 N2 - PURPOSE: To estimate the risk (and determinants) of discontinuing cholinesterase inhibitors (ChEIs) in a population-based sample of Alzheimer's disease (AD) patients. METHODS: This is a retrospective cohort study based on linked de-identified administrative health data from the province of Saskatchewan, Canada. The cohort included all AD patients receiving a ChEI prescription during the first year of provincial coverage (2000-2001). Persistence was defined as no gap of 60+ days between depletion and subsequent refill of a ChEI prescription. Kaplan-Meier analysis was used to estimate the risk of discontinuation over 40 months. Cox regression with time-varying covariates was used to assess risk factors for ChEI discontinuation. RESULTS: The sample included 1080 patients (64% female, average age 80 +/- 7 years). Baseline mean (SD) Mini-Mental State Examination (MMSE) and Functional Activities Questionnaire (FAQ) scores were 20.8 (4.4) and 17.5 (7.7), respectively. Over 40 months, 84% discontinued therapy. The 1-year risk of discontinuation was 66.4% (95%CI 63.5-69.3%). Discontinuation was significantly more likely for females (adjusted HR 1.34, 95%CI 1.16-1.55) and among those with lower MMSE scores (2.52, 2.01-3.17 if <15), not receiving social assistance (1.25, 1.07-1.45), and paying at least 65% of total prescription costs (1.51, 1.30-1.74). It was significantly less likely for patients with frequent physician visits (0.78, 0.66-0.93, for 7-19 vs. <7 visits), higher Chronic Disease Scores (0.74, 0.61-0.89, for 7+ vs. <4), and FAQ scores of 9+ (0.82, 0.69-0.99). CONCLUSION: The likelihood of discontinuing ChEI therapy was high in this real-world sample of AD patients. Significant predictors included clinical, socioeconomic, and practice factors. SN - 1099-1557 UR - https://www.unboundmedicine.com/medline/citation/20583207/Persistence_with_cholinesterase_inhibitor_therapy_in_a_population_based_cohort_of_patients_with_Alzheimer's_disease_ L2 - https://doi.org/10.1002/pds.1946 DB - PRIME DP - Unbound Medicine ER -