Adherence and Tolerability of Alzheimer's Disease Medications: A Pragmatic Randomized Trial

• Autores: Noll L. Campbell, Anthony J. Perkins, Sujuan Gao, Todd C. Skaar, Lang Li--, Hugh C. Hendrie, Nicole R. Fowler, Christopher M. Callahan, Malaz A. Boustani
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 65, Nº. 7, 2017, págs. 1497-1504
• Idioma: inglés
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• Resumen

  • Background/Objectives Post-marketing comparative trials describe medication use patterns in diverse, real-world populations. Our objective was to determine if differences in rates of adherence and tolerability exist among new users to acetylcholinesterase inhibitors (AChEI's).

    Design Pragmatic randomized, open label comparative trial of AChEI's currently available in the United States.

    Setting Four memory care practices within four healthcare systems in the greater Indianapolis area.

    Participants Eligibility criteria included older adults with a diagnosis of possible or probable Alzheimer's disease (AD) who were initiating treatment with an AChEI. Participants were required to have a caregiver to complete assessments, access to a telephone, and be able to understand English. Exclusion criteria consisted of a prior severe adverse event from AChEIs.

    Intervention Participants were randomized to one of three AChEIs in a 1:1:1 ratio and followed for 18 weeks.

    Measurements Caregiver-reported adherence, defined as taking or not taking study medication, and caregiver-reported adverse events, defined as the presence of an adverse event.

    Results 196 participants were included with 74.0% female, 30.6% African Americans, and 72.9% who completed at least twelfth grade. Discontinuation rates after 18 weeks were 38.8% for donepezil, 53.0% for galantamine, and 58.7% for rivastigmine (P = .063) in the intent to treat analysis. Adverse events and cost explained 73.1% and 25.4% of discontinuation. No participants discontinued donepezil due to cost. Adverse events were reported by 81.2% of all participants; no between-group differences in total adverse events were statistically significant.

    Conclusions This pragmatic comparative trial showed high rates of adverse events and cost-related non-adherence with AChEIs. Interventions improving adherence and persistence to AChEIs may improve AD management.