title: Dose and plasma concentration of galantamine in Alzheimer's disease - clinical application.
abstract: BACKGROUND
  Patients with Alzheimer's disease (AD) are currently treated with cholinesterase inhibitors, such as galantamine, without actual knowledge of its concentration in plasma. Our objective was to analyse potential relationships between galantamine concentration, galantamine dose, socio-demographic characteristics, body weight, body mass index (BMI), and treatment response.
  
  
  METHODS
  Eighty-four patients with AD recruited from the Memory Clinic, Malmö, Sweden, and treated with galantamine were included in the study. Efficacy measures, including cognition (Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-cog)) and instrumental activities of daily living (IADL), were evaluated at baseline, 2 months after treatment initiation (MMSE only) and semi-annually over 3 years. At these assessments, blood samples were obtained for the analysis of the galantamine concentration, and body weight, BMI, drug dose and time from drug intake were recorded.
  
  
  RESULTS
  All patients had a measurable concentration of galantamine at all assessments. The mean plasma concentration of the drug exhibited a positive linear association with dose (r = 0.513, P < 0.001). The dose did not differ between sexes. Negative linear associations between the galantamine plasma concentration and BMI (r = -0.454, P = 0.001) or body weight (r = -0.310, P = 0.034) were found exclusively in the male group. When mixed-effects models were used, the dose of galantamine (P < 0.001), time from drug intake (P < 0.001), and BMI (P = 0.021) or weight (P = 0.002) were factors that predicted the concentration, whereas sex, age, and cognitive and functional changes were not.
  
  
  CONCLUSIONS
  High compliance to galantamine treatment was found among all patients in this naturalistic AD study. The impact of BMI or body weight on the plasma concentration of galantamine was important only among males. No relationship was observed between concentration and short-term treatment response or progression rate in terms of cognitive and functional abilities.
authors.affiliation: Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02 Malmö, Sweden ; Memory Clinic, Skåne University Hospital, SE-205 02 Malmö, Sweden.
authors.forename: Carina
authors.initials: C
authors.lastname: Wattmo
authors.affiliation: Alzheimer Disease Research Centre, Department of Neurobiology, Caring Sciences and Society, Karolinska Institute, Hälsovägen 7, SE-141 86 Stockholm, Sweden ; Medical Department, Janssen-Cilag AB, Staffansväg 2, SE-192 78 Sollentuna, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Jedenius
authors.affiliation: Clinical Neurochemistry Laboratory, Institution of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-431 80 Mölndal, Sweden.
authors.forename: Kaj
authors.initials: K
authors.lastname: Blennow
authors.affiliation: Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, SE-205 02 Malmö, Sweden ; Memory Clinic, Skåne University Hospital, SE-205 02 Malmö, Sweden.
authors.forename: Asa K
authors.initials: AK
authors.lastname: Wallin