Donepezil is associated with delayed nursing home placement in patients with Alzheimer's disease
Donepezil is associated with delayed nursing home placement in patients with Alzheimer's disease
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DOI：
10.1046/j.1365-2389.2003.51306.x
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发表时间：
2003-07-01
影响因子：
6.3
通讯作者：
Ieni, JR
中科院分区：
文献类型：
--
作者：
Geldmacher, DS;Provenzano, G;Ieni, JR
目的：评估多奈哌齐治疗与阿尔茨海默病（AD）患者入住疗养院（NHP）时间之间的关系。设计：观察性随访患者NHP和生命状态。地点：社区。参与者：患者先前参加了三项多奈哌齐随机、双盲、安慰剂对照临床试验之一，以及随后的两项开放标签研究（总N = 1，115）; 671名患者提供了完整的数据进行分析。测量：通过与护理人员的随访访谈和AD患者的图表回顾获得数据。比较组的定义是患者是否在双盲或开放标签试验阶段接受有效剂量的多奈哌齐（大于或等于5 mg/d;大于或等于80%的依从性），持续特定的周数，在两个阶段，或在两个阶段都没有。考克斯比例风险模型用于估计NHP的风险比和生存曲线，从中估计首次痴呆相关安置超过2周和永久安置的NHP中位时间。模型进行了调整，年龄，性别，基线迷你精神状态检查评分，无论是照顾者的配偶，照顾者的连续性，并使用其他胆碱酯酶抑制剂后的临床试验。在长期持续使用多奈哌齐和NHP延迟之间观察到累积剂量-反应关系。当多奈哌齐采取有效剂量为至少9至12个月，保守估计的时间前获得NHP为21.4个月的第一次痴呆相关的NHP和17.5个月的永久NHP.CONCLUSION：AD患者使用多奈哌齐导致NHP显着延迟。长期使用多奈哌齐可以帮助AD患者在社区环境中活得更长，从而带来个人，社会和经济效益。
OBJECTIVES: To assess the relationship between donepezil treatment and time to nursing home placement (NHP) for patients with Alzheimer's disease (AD).DESIGN: Observational follow-up of patient NHP and vital status.SETTING: Community.PARTICIPANTS: Patients previously enrolled in one of three randomized, double-blind, placebo-controlled clinical trials of donepezil and two subsequent open-label studies (total N = 1,115); 671 patients provided complete data for analysis.MEASUREMENTS: Data were obtained through follow-up interviews with caregivers and chart reviews of patients with AD. Comparison groups were defined by whether patients received an effective dose of donepezil (greater than or equal to5 mg/d; greater than or equal to80% compliance) for specific numbers of weeks during the double-blind or open-label trial phase, in both phases, or in neither. Cox proportional hazards models were used to estimate risk ratios for NHP and survival curves from which median times to NHP were estimated for first dementia-related placement of longer than 2 weeks and permanent placement. The models were adjusted for age, sex, baseline Mini-Mental State Examination score, whether the caregiver was a spouse, caregiver continuity, and use of other cholinesterase inhibitors after the clinical trials.RESULTS: Use of donepezil of 5 mg/d or more was associated with significant delays in NHP. A cumulative dose-response relationship was observed between longer-term sustained donepezil use and delay of NHP. When donepezil was taken at an effective dose for at least 9 to 12 months, conservative estimates of the time gained before NHP were 21.4 months for first dementia-related NHP and 17.5 months for permanent NHP.CONCLUSION: Use of donepezil by AD patients resulted in significant delays in NHP. Long-term use of donepezil may help AD patients live longer in community settings, with consequent personal, social, and economic benefits.