title: Relationship between the efficacy of rivastigmine and apolipoprotein E (epsilon4) in patients with mild to moderately severe Alzheimer disease.
abstract: Alzheimer disease is the most common form of dementia in Western countries and the leading cause of disability in the over-65 population. Apolipoprotein E (APOE) is a multifunctional protein implied in lipid metabolism and neurobiology. Polymorphisms of the APOE gene have been associated with a variety of medical disorders, from arteriosclerosis to AD. A high frequency of the APOE epsilon4 allele has been found in patients with AD and they seem to have a higher risk of developing the disease. Various authors have suggested a possible relationship between the efficacy of cholinesterase inhibitors and the presence of the APOE epsilon4 allele. The purpose of the present study was to compare prospectively the efficacy of rivastigmine in patients with mild to moderately severe AD presenting different polymorphisms of the APOE gene on chromosome 19 and to determine if there was a difference in the response to rivastigmine treatment in AD patients with the APOE epsilon4 allele (heterozygous or homozygous) versus patients who had other forms of APOE, such as epsilon2 and epsilon3. This was an open-label, nonrandomized, multicenter study in patients over 50 years of age diagnosed with mild to moderately severe AD. The results of the analysis of this study indicate that the presence of at least one APOE epsilon4 allele does not determine a difference in the response to treatment with rivastigmine. The data indicate that knowledge of the patient's genotype is not necessary for treatment with rivastigmine. It would be interesting in the future to analyze the interaction between these 2 factors using other available anticholinesterase drugs.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. rblesa@hsp.santpau.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Blesa
authors.forename: Miquel
authors.initials: M
authors.lastname: Aguilar
authors.forename: Jordi Peña
authors.initials: JP
authors.lastname: Casanova
authors.forename: Mercé
authors.initials: M
authors.lastname: Boada
authors.forename: Sergi
authors.initials: S
authors.lastname: Martínez
authors.forename: Jordi
authors.initials: J
authors.lastname: Alom
authors.forename: Carlos Hernández
authors.initials: CH
authors.lastname: de la Hoz
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Sancho
authors.forename: Oscar
authors.initials: O
authors.lastname: Fernández
authors.forename: Eulogio
authors.initials: E
authors.lastname: Gil-Neciga
authors.forename: Jose Félix Martí
authors.initials: JF
authors.lastname: Massó
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000235:genetics*; D053329:Apolipoprotein E2 / Q000235:genetics; D053318:Apolipoprotein E3 / Q000235:genetics; D053327:Apolipoprotein E4 / Q000235:genetics*; D004351:Drug Resistance / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D048448:Phenylcarbamates / Q000627:therapeutic use*; D011110:Polymorphism, Genetic; D000068836:Rivastigmine; D016896:Treatment Outcome
chemical_list: D053329:Apolipoprotein E2; D053318:Apolipoprotein E3; D053327:Apolipoprotein E4; D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000068836:Rivastigmine