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Antidementia drug use among community-dwelling individuals with Alzheimers disease in Finland: a nationwide register-based study

Taipale, Heidia,b; Tanskanen, Anttie,f; Koponen, Marjaanaa,b; Tolppanen, Anna-Maijab,c; Tiihonen, Jarid,f; Hartikainen, Sirpaa,b

International Clinical Psychopharmacology: July 2014 - Volume 29 - Issue 4 - p 216–223
doi: 10.1097/YIC.0000000000000032
Original Articles

The objective of this study was to investigate the prevalence of acetylcholinesterase inhibitor (AChEI) and memantine use, duration of treatment, concomitant use of these drugs, and factors associated with the discontinuation of AChEI therapy during 2006–2009. We utilized data from a nationwide sample of community-dwelling individuals with a clinically verified Alzheimer’s disease diagnosed during the year 2005 (n=6858) as a part of the MEDALZ-2005 study. During the 4-year follow-up, 84% used AChEI and 47% used memantine. Altogether, 22% of the sample used both drugs concomitantly. The median duration of the first AChEI use period was 860 (interquartile range 295–1458) days and 1103 (interquartile range 489–1487) days for the total duration of AChEI use. Although 20% of the AChEI users discontinued the use during the first year, over half of them restarted later. The risk of discontinuation was higher for rivastigmine [hazard ratio 1.34 (confidence interval 1.22–1.48)] and galantamine users [hazard ratio 1.23 (confidence interval 1.15–1.37)] compared with donepezil users in the adjusted model. In conclusion, median time for AChEI use was over 3 years and every fifth Alzheimer’s disease patient used AChEI and memantine concomitantly during the follow-up. The low rate of discontinuation is consistent with the Finnish Care Guideline but in contrast to the results reported from many other countries.

aKuopio Research Centre of Geriatric Care

bSchool of Pharmacy

cResearch Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland

dDepartment of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio

eNational Institute for Health and Welfare, Helsinki, Finland

fDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Correspondence to Heidi Taipale, PhD (Pharm), Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211 Kuopio, Finland Tel: +358 443 361 265; fax: +358 171 62424; e-mail: heidi.taipale@uef.fi

Received September 30, 2013

Accepted February 4, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins