title: [Rivastigmine as treatment for patients with mild to moderately severe Alzheimer disease under normal clinical practice conditions. The ENTERPRISE study].
abstract: BACKGROUND
  Alzheimer disease (AD) causes progressive cognitive decline leading to loss of independence for activities of daily living; rivastigmine is one of the drugs used for symptomatic management.
  
  
  OBJECTIVE
  To assess the therapeutic use of different pharmaceutical forms of rivastigmine in patients with AD in normal clinical practice.
  
  
  METHODS
  Cross-sectional, observational, multi-centre study conducted on patients with mild to moderate AD treated with rivastigmine in Spanish outpatient clinics specialising in Geriatrics, Psychiatry, and Neurology. Data regarding use of oral (OR) and transdermal (TDR) rivastigmine, compliance (degree of adherence), and caregiver satisfaction with treatment were evaluated.
  
  
  RESULTS
  In total, 2252 patients with a mean age of 77.2 years were included; 60.2% were women. AD was moderate to moderately severe in 58.4%. Rivastigmine treatment was started orally in 54.4% of the patients and transdermally in 45.6%; 35.6% of those who started treatment by the OR route switched to TDR. A single dose adjustment was sufficient for 77.5% of patients on TDR treatment vs 11.8% of patients receiving OR treatment. More patients on TDR treatment (80.8% vs. 57.1% on OR treatment) reached the maximum therapeutic dose of rivastigmine and did so in a shorter period of time (51.6 vs 205.8 days). Compliance rates (60.5% vs 47.2%) and caregivers' satisfaction with treatment (89.4% vs 81.9%) were also higher for TDR.
  
  
  CONCLUSIONS
  In normal clinical practice, using the TDR route of administration improves dose titration and drug compliance, allowing more patients to reach the maximum recommended dose of rivastigmine in a shorter time period.
authors.affiliation: Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, España. Electronic address: alfonsojose.cruz@salud.madrid.org.
authors.forename: A J
authors.initials: AJ
authors.lastname: Cruz Jentoft
authors.affiliation: Novartis Farmacéutica, S.A., Barcelona, España.
authors.forename: B
authors.initials: B
authors.lastname: Hernández
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010349:Patient Compliance; D017060:Patient Satisfaction; D048448:Phenylcarbamates / Q000627:therapeutic use*; D000068836:Rivastigmine
chemical_list: D002800:Cholinesterase Inhibitors; D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D000068836:Rivastigmine
keywords: Administration route; Alzheimer; Compliance; Cumplimiento; Manejo terapéutico; Rivastigmina; Rivastigmine; Satisfacción; Satisfaction; Treatment management; Vía de administración