Discontinuation of donepezil for the treatment of Alzheimer's disease in geriatric practice
Discontinuation of donepezil for the treatment of Alzheimer's disease in geriatric practice
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DOI：
10.1017/s1041610208007011
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发表时间：
2008-08-01
影响因子：
7
通讯作者：
Nabeshima, Toshitaka
中科院分区：
文献类型：
--
作者：
Umegaki, Hiroyuki;Itoh, Akio;Nabeshima, Toshitaka
背景：痴呆患者维持持续的药物治疗往往是困难的。在本次研究中，我们调查了日本一所大学医院的老年门诊中停用胆碱酯酶抑制剂多奈哌齐治疗阿尔茨海默病的情况。方法：采用回顾性图表回顾的方法，确定某大学医院2003年7月1日至2005年6月30日期间停用多奈哌齐的处方和停药原因。结果：264例患者中，有140例(53.1%)在两年观察期内停止服用多奈哌齐。持续组和停药组的平均年龄无显著差异(分别为79.5±6.7，79.8±-6.4)。Kaplan-Meier分析显示，认知功能障碍程度较重(CDR评分3分)的患者停用多奈哌齐的时间更早、频率更高。停药原因依次为：更换医生71例，无效16例，胃肠道副作用11例，其他4 1例。在CDR=1或2的患者中，更换医生是最常见的停药原因。然而，在CDR=3的患者中，药物无效是停药的主要原因。结论：多奈哌齐经常被停用，且晚期痴呆患者的停药率较高。
Background: Maintaining continuous pharmacological treatment of patients with dementia is often difficult. In the current study we surveyed the discontinuation of donepezil, a cholinesterase inhibitor, for the treatment of Alzheimer's disease in a Japanese geriatric outpatient clinic in a university hospital.Methods: Using a retrospective chart review from 1 July 2003 to 30 June 2005, prescriptions of donepezil and the reasons for discontinuing the prescription in a university hospital were determined. The severity of dementia was evaluated by the clinical dementia rating (CDR).Results: Out of 264 patients, 140 (53.1%) discontinued taking donepezil during the two-year observation period. The mean age of the continued group and the discontinued group did not differ significantly (79.5 +/- 6.7, 79.8 +/- 6.4, respectively). Kaplan-Meier analysis showed that the patients with more severe cognitive impairment (CDR score = 3) discontinued donepezil earlier and more frequently. The reasons for discontinuation were a change in the doctors treating the patients (n = 71), ineffectiveness (n = 16), gastrointestinal side-effects (n = 11), and others (n = 4 1). In patients with CDR = 1 or 2, changes of doctors were the most frequent reason for discontinuation. However, in patients with CDR = 3, ineffectiveness of the medication was the major reason for discontinuation.Conclusion: Donepezil was frequently discontinued, and the rate of discontinuation was higher in patients with advanced dementia.