Cholinesterase inhibitors for Alzheimer disease: do they provide more than symptomatic benefits?
OBJECTIVE
This study aims to examine survival of patients with Alzheimer disease (AD) receiving clinical efficacy of cholinesterase inhibitors (ChEIs) and to compare their survival with those of patients with AD who never received ChEIs and cognitively intact old psychiatric outpatients.


METHODS
The retrospective cohort study used national mortality data provided by the Korean National Statistics Office and electronic database of 15 general hospitals on older patients who began outpatient treatment with psychiatric medications including ChEIs (N = 3,813). The authors controlled for confounding by using multivariate models and propensity scoring methods.


METHODS
Mortality rate of patients with AD receiving ChEIs was compared with those of patients with AD who never received ChEIs and cognitively intact old psychiatric outpatients.


RESULTS
Observed additional survival of patients with AD receiving ChEIs (mortality rate: 13.1%), when compared with patients with AD who never received ChEIs (15.4%) was not statistically significant (p = 0.74; hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.67-1.59). Patients with AD receiving ChEIs showed higher mortality rate (13.1%) compared with that of cognitively intact old psychiatric outpatients (8.6%) (p <0.001; HR: 1.60, 95% CI: 0.96-2.68).


CONCLUSIONS
This study does not support that ChEIs increase survival of patients with AD, compared with patients with AD who have never treated with ChEIs. Therefore, all ChEIs should be considered for symptomatic use only and not to be capable of modifying mortality of patients with AD.
Suh
Guk-Hee
GH
Department of Psychiatry, Hallym University Medical Center, Hangang Sacred Heart Hospital, Seoul, Korea. suhgh@chol.com
Ryu
Seung-Ho
SH
Lee
Dong-Woo
DW
Han
Changsu
C
Ju
Young-Su
YS
Kee
Baik Seok
BS
Lee
Joon-Noh
JN
Bae
Jae Nam
JN
Choi
Jong-Hyuk
JH
Kim
Dai-Jin
DJ
Lee
Nam-Jin
NJ
Lee
Jun-Young
JY
Go
Hyo-Jin
HJ
Yi
Jung-Seo
JS
Cho
Seong-Jin
SJ
Jeon
Yang-Whan
YW
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000401:mortality; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies
D002800:Cholinesterase Inhibitors