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Rivastigmine transdermal patch and capsule in Alzheimer's disease: influence of disease stage on response to therapy.
Int J Geriatr Psychiatry. 2011 Dec; 26(12):1236-43.IJ

Abstract

OBJECTIVES

The cholinesterase inhibitor rivastigmine is approved for the symptomatic treatment of mild to moderate Alzheimer's disease (AD). This exploratory, hypothesis-forming analysis assessed response to rivastigmine according to severity of dementia at baseline.

METHODS

This was a retrospective analysis of a large randomized, placebo-controlled trial (ENA713D2320). AD patients treated with 9.5 mg/24 h rivastigmine patch, 17.4 mg/24 h rivastigmine patch, rivastigmine capsule (12 mg/day), or placebo were stratified according to baseline Mini-Mental State Examination (MMSE) scores: ≥7 to ≤12 (severe disease), ≥13 to ≤15 (moderately severe), ≥16 to ≤18 (moderate), or ≥19 to ≤25 (mild to moderate). Changes from baseline at Week 24 on Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC), and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) were assessed.

RESULTS

Based on baseline MMSE scores, 141, 228, 333, and 348 patients had severe, moderately severe, moderate, and mild to moderate dementia. Worsening of ADAS-cog, ADCS-CGIC, and ADCS-ADL scores in patients receiving placebo were greater in patients with more severe dementia. Significant improvements versus placebo were seen with rivastigmine patch and/or capsule on ADAS-cog, ADCS-CGIC, and ADCS-ADL scores in patients with severe, moderately severe, and moderate AD (all p < 0.05). However, no significant improvements were seen in rivastigmine-treated patients with mild to moderate AD.

CONCLUSIONS

Rivastigmine benefits AD patients across dementia stages. Similar to previous cholinesterase inhibitor studies, greatest treatment effects with rivastigmine patch and capsule were seen in patients with more advanced dementia, most likely driven by greater placebo decline in this population.

Authors+Show Affiliations

Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA. mfarlow@iupui.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22068922

Citation

Farlow, Martin R., et al. "Rivastigmine Transdermal Patch and Capsule in Alzheimer's Disease: Influence of Disease Stage On Response to Therapy." International Journal of Geriatric Psychiatry, vol. 26, no. 12, 2011, pp. 1236-43.
Farlow MR, Grossberg GT, Meng X, et al. Rivastigmine transdermal patch and capsule in Alzheimer's disease: influence of disease stage on response to therapy. Int J Geriatr Psychiatry. 2011;26(12):1236-43.
Farlow, M. R., Grossberg, G. T., Meng, X., Olin, J., & Somogyi, M. (2011). Rivastigmine transdermal patch and capsule in Alzheimer's disease: influence of disease stage on response to therapy. International Journal of Geriatric Psychiatry, 26(12), 1236-43. https://doi.org/10.1002/gps.2669
Farlow MR, et al. Rivastigmine Transdermal Patch and Capsule in Alzheimer's Disease: Influence of Disease Stage On Response to Therapy. Int J Geriatr Psychiatry. 2011;26(12):1236-43. PubMed PMID: 22068922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rivastigmine transdermal patch and capsule in Alzheimer's disease: influence of disease stage on response to therapy. AU - Farlow,Martin R, AU - Grossberg,George T, AU - Meng,Xiangyi, AU - Olin,Jason, AU - Somogyi,Monique, Y1 - 2010/12/23/ PY - 2010/07/28/received PY - 2010/11/03/accepted PY - 2011/11/10/entrez PY - 2011/11/10/pubmed PY - 2012/1/10/medline SP - 1236 EP - 43 JF - International journal of geriatric psychiatry JO - Int J Geriatr Psychiatry VL - 26 IS - 12 N2 - OBJECTIVES: The cholinesterase inhibitor rivastigmine is approved for the symptomatic treatment of mild to moderate Alzheimer's disease (AD). This exploratory, hypothesis-forming analysis assessed response to rivastigmine according to severity of dementia at baseline. METHODS: This was a retrospective analysis of a large randomized, placebo-controlled trial (ENA713D2320). AD patients treated with 9.5 mg/24 h rivastigmine patch, 17.4 mg/24 h rivastigmine patch, rivastigmine capsule (12 mg/day), or placebo were stratified according to baseline Mini-Mental State Examination (MMSE) scores: ≥7 to ≤12 (severe disease), ≥13 to ≤15 (moderately severe), ≥16 to ≤18 (moderate), or ≥19 to ≤25 (mild to moderate). Changes from baseline at Week 24 on Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC), and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) were assessed. RESULTS: Based on baseline MMSE scores, 141, 228, 333, and 348 patients had severe, moderately severe, moderate, and mild to moderate dementia. Worsening of ADAS-cog, ADCS-CGIC, and ADCS-ADL scores in patients receiving placebo were greater in patients with more severe dementia. Significant improvements versus placebo were seen with rivastigmine patch and/or capsule on ADAS-cog, ADCS-CGIC, and ADCS-ADL scores in patients with severe, moderately severe, and moderate AD (all p < 0.05). However, no significant improvements were seen in rivastigmine-treated patients with mild to moderate AD. CONCLUSIONS: Rivastigmine benefits AD patients across dementia stages. Similar to previous cholinesterase inhibitor studies, greatest treatment effects with rivastigmine patch and capsule were seen in patients with more advanced dementia, most likely driven by greater placebo decline in this population. SN - 1099-1166 UR - https://www.unboundmedicine.com/medline/citation/22068922/Rivastigmine_transdermal_patch_and_capsule_in_Alzheimer's_disease:_influence_of_disease_stage_on_response_to_therapy_ L2 - https://doi.org/10.1002/gps.2669 DB - PRIME DP - Unbound Medicine ER -