A Real-world Analysis of Treatment Patterns for Cholinesterase Inhibitors and Memantine among Newly-diagnosed Alzheimer's Disease Patients.
A Real-world Analysis of Treatment Patterns for Cholinesterase Inhibitors and Memantine among Newly-diagnosed Alzheimer's Disease Patients.
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DOI：
10.1007/s40120-017-0067-7
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发表时间：
2017-06
影响因子：
3.7
通讯作者：
Fillit H
中科院分区：
文献类型：
--
作者：
Bent-Ennakhil N;Coste F;Xie L;Aigbogun MS;Wang Y;Kariburyo F;Hartry A;Baser O;Neumann P;Fillit H
阿尔茨海默病（AD）是最常见的神经退行性痴呆。自2000年以来，美国已开始使用乙酰胆碱酯酶抑制剂（AChEIs）和美金刚等对症药物治疗。在过去的十年中，很少有研究分析了美国现实世界的抗痴呆治疗模式。本研究评估了新诊断AD患者的单药AChEIs和美金刚治疗模式。采用2008 - 2012年的医疗保险数据和最小数据集进行回顾性队列研究。年龄65-100岁的新诊断AD患者（ICD-9代码：331.0），诊断后开始单药AChEI或美金刚治疗。进行了描述性治疗模式分析，包括停药和切换。绘制Kaplan-Meier曲线来检验治疗时间。共发现9812例新诊断的AD患者，其中56.7% （n = 5567）在首次AD诊断后首次接受抗痴呆治疗。在AD诊断后开始单药AChEIs或美金刚的患者（N = 5200）中，51.6%的患者在整个随访期间（平均随访659.7天）继续接受指数治疗，21.7%的患者停止治疗。在那些开始用乙酰氨基酚i单药治疗的患者中，11.1%接受了美金刚的辅助治疗。在连续治疗≥1年（平均随访：834天）的患者中，75.6%的患者仍在使用指标药物，10.2%的患者在剩余随访期间停止使用，9.5%的AD患者在剩余随访期间接受了辅助美金刚治疗。在美国医疗保险人群中，在诊断后开始使用乙酰氨基酚i或美金刚治疗的患者中，约有50%的患者继续进行指数治疗，超过20%的患者在观察期间停止治疗并未接受治疗。开始使用乙酰氨基甲酸乙酯或美金刚的AD患者如果持续治疗一年，则更有可能继续治疗。本文的在线版本（doi:10.1007/s40120-017-0067-7）包含补充材料，仅供授权用户使用。
Alzheimer’s disease (AD) is the most common neurodegenerative form of dementia. Pharmacological therapies for symptomatic treatment, such as acetylcholinesterase inhibitors (AChEIs) and memantine, have been available in the USA since 2000. Over the past decade, few studies have analyzed real-world anti-dementia treatment patterns in the USA. This study evaluated monotherapy AChEIs and memantine treatment patterns among newly diagnosed AD patients. A retrospective cohort study was conducted using Medicare data and the Minimum Data Set from 2008 to 2012. Patients aged 65–100 years with newly diagnosed AD (ICD-9 code: 331.0) and monotherapy AChEI or memantine treatment initiated after diagnosis were included. Descriptive treatment pattern analyses, including discontinuation and switch, were undertaken. Kaplan–Meier curves were developed to examine the treatment duration. A total of 9812 newly diagnosed AD patients were identified, with 56.7% (n = 5567) first receiving anti-dementia treatment after the initial AD diagnosis. Among patients initiating monotherapy AChEIs or memantine after AD diagnosis (N = 5200), 51.6% continued index treatment during the entire follow-up period (mean follow-up: 659.7 days) and 21.7% discontinued treatment. Of those who initiated monotherapy treatment with an AChEI, 11.1% received adjunct therapy with memantine. Among patients with ≥1 year of continuous treatment (mean follow-up: 834 days), 75.6% remained on the index drug, 10.2% discontinued during the remaining follow-up period, and 9.5% of the AD patients initiating AChEIs received adjunct memantine therapy during the remaining follow-up period. In the USA Medicare population, about 50% of the patients who initiated treatment with AChEI or memantine after diagnosis continued the index treatment, and more than 20% discontinued and were untreated afterwards over the observation period. AD patients initiating AChEIs or memantine were more likely to remain on their treatment if they were persistently treated for the first year. The online version of this article (doi:10.1007/s40120-017-0067-7) contains supplementary material, which is available to authorized users.