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Title: Rivastigmine May Reduce Need for Antipsychotic Drugs in Alzheimer's Disease: Presented at ICAD
URL: http://www.pslgroup.com/dg/226C8E.htm
Doctor's Guide
August 1, 2008

By Ed Susman

CHICAGO -- August 1, 2008 -- Patients diagnosed with Alzheimer's disease who are treated with rivastigmine experience less of a need for antipsychotic drugs than patients who were treated with donepezil, according to a retrospective analysis.

"I believe we need a clinical trial to determine if this difference in outcome can be replicated in a prospective manner," said Douglas W. Scharre, MD, Department of Neurology, Ohio State University, Columbus, Ohio.

During a 3-year period -- January 2004 to December 2006 -- about 5.6% of patients diagnosed with mild to moderate Alzheimer's disease who were treated with rivastigmine and 8.1% of similar patients treated with donepezil were prescribed antipsychotic medication -- an indication of a worsening condition, Dr. Scharre said. This difference translates into a 34% reduction in the use of antipsychotic medication, he added.

"Based on this real-world data from more than 7,500 antipsychotic-naive patients with Alzheimer's disease, rivastigmine was found to be associated with a significant reduction [P = .0305] in the emergent use of antipsychotic drugs, relative to donepezil," Dr. Scharre said during his poster presentation on July 30 at the 2008 International Conference on Alzheimer's Disease (ICAD).

For the analysis, researchers scrutinised the MedStat MarketScan database of health claims. They identified 532 patients taking rivastigmine and 7,264 patients taking donepezil. The average ages of the 2 groups were 79 and 81 years -- a significant difference (P = .0044). There was also a higher percentage of women in the donepezil group (59% for donepezil vs 53% for rivastigmine), another significant difference (P = .0053) and a possible confounder, according to Dr. Scharre.

He said the overwhelming use of donepezil compared with rivastigmine may have biased the outcome. Other limitations of the study included the possibility that the antipsychotics were prescribed for off-label use and the data do not consider compliance issues.

"Further randomised studies are warranted to validate these findings," he said.

Funding for this study was provided by Novartis Pharmaceutical Corporation.


[Presentation title: Antipsychotic Drug Use in Patients With Alzheimer's Disease Treated With Rivastigmine Versus Donepezil: Evidence From Health Claims Data. Abstract P4-308]

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