Anti-Dementia Drugs and Co-Medication Among Patients with Alzheimer's Disease Investigating Real-World Drug Use in Clinical Practice Using the Swedish Dementia Quality Registry (SveDem)
Anti-Dementia Drugs and Co-Medication Among Patients with Alzheimer's Disease Investigating Real-World Drug Use in Clinical Practice Using the Swedish Dementia Quality Registry (SveDem)
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DOI：
10.1007/s40266-014-0154-8
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发表时间：
2014-03-01
期刊：
影响因子：
2.8
通讯作者：
Eriksdotter, Maria
中科院分区：
文献类型：
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作者：
Fereshtehnejad, Seyed-Mohammad;Johnell, Kristina;Eriksdotter, Maria
背景：在虚弱的阿尔茨海默病（AD）患者中存在药物相互作用、不良事件和不适当用药（IDU）的重大风险；然而，在临床环境中，关于联合用药和IDU的研究很少。目的探讨抗痴呆药物、胆碱酯酶抑制剂（ChEIs）和NMDA拮抗剂的相关特征、联合用药和IDU在大量轻度AD门诊患者中的应用。方法：在这项药物特征的横断面分析中，我们分析了瑞典痴呆症质量登记处（SveDem）中5907名在记忆诊所登记的新诊断的AD患者的数据。SveDem是瑞典的一个国家质量登记处，成立于2007年，旨在评估和改善痴呆症医疗保健。比较在抗痴呆治疗（ChEIs或NMDA拮抗剂）的基础上，共同用药、使用>= 3种精神药物（IDU）和多种药物（>= 5种药物）的情况。基线特征信息，如年龄、性别、生活条件、基于迷你精神状态检查（MMSE）评分的认知评估和诊断检查也进行了评估。结果AD患者以轻症期为主。总体而言，4342例（75.4%）患者接受了ChEI治疗，438例（7.6%）患者使用了NMDA拮抗剂，74例（1.3%）患者同时接受了两种治疗。然而，907例（15.7%）患者未接受任何抗痴呆药物治疗。33.5%的患者同时使用bb0 = 3种精神药物，仅有2.6%的患者同时使用bb0 = 3种精神药物。接受ChEIs治疗的患者明显更年轻，MMSE评分更高，使用的药物数量更少（总体合并症的替代指标）。与抗精神病药物联合用药[3.3%对7.6%；调整优势比（OR） 0.55 (95% CI 0.38-0.79)]和抗焦虑药[5.8比10.9%；经校正OR 0.62 (95% CI 0.46-0.84)]显著低于未接受抗痴呆治疗组。结论与未服用ChEIs的患者相比，服用ChEIs的患者使用的抗精神病药物和抗焦虑药物较少。需要更多的研究来阐明在临床实践中使用ChEIs是否可以减少AD患者对精神药物的需求。
Background There is a substantial risk of drug-interactions, adverse events, and inappropriate drug use (IDU) among frail Alzheimer's disease (AD) patients; however, there are few studies about co-medication and IDU in clinical settings.Objectives To investigate anti-dementia drugs, associated characteristics of cholinesterase inhibitors (ChEIs) and NMDA antagonists, co-medication, and IDU in a large population of outpatients with mild AD.Methods In this cross-sectional analysis of medication characteristics, we analyzed data from the Swedish Dementia Quality Registry (SveDem) on 5,907 newly diagnosed AD patients who were registered in memory clinics. SveDem is a national quality registry in Sweden, which was established in 2007 to evaluate and improve dementia healthcare. Comparisons were performed concerning co-medications, use of >= 3 psychotropic drugs (IDU) and polypharmacy (>= 5 drugs) based on anti-dementia treatment (ChEIs or NMDA antagonists). Information on baseline characteristics such as age, sex, living conditions, cognitive evaluation based on the Mini-Mental State Examination (MMSE) score, and diagnostic work-up was also evaluated.Results The majority of the AD patients were in the mild stage of the disease. Overall, 4,342 (75.4 %) patients received any ChEI, 438 (7.6 %) used an NMDA antagonist and 74 (1.3 %) patients were treated with both. However, 907 (15.7 %) patients were not treated with any anti-dementia drug. While polypharmacy was seen in 33.5 % of patients, only 2.6 % concurrently used >= 3 psychotropic medications. Patients on ChEIs were significantly younger, had a higher MMSE score and were treated with a smaller number of medications (a proxy for overall co-morbidity). Co-medication with antipsychotics [3.3 vs. 7.6 %; adjusted odds ratio (OR) 0.55 (95 % CI 0.38-0.79)] and anxiolytics [5.8 vs. 10.9 %; adjusted OR 0.62 (95 % CI 0.46-0.84)] was significantly lower in the ChEI+ group than in those with no anti-dementia treatment.Conclusion Patients taking ChEIs were treated with less antipsychotics and anxiolytics than those not taking ChEIs. More research is warranted to elucidate whether use of ChEIs in clinical practice can reduce the need for psychotropic drugs in AD patients.