title: The transdermal formulation of rivastigmine improves caregiver burden and treatment adherence of patients with Alzheimer's disease under daily practice conditions.
abstract: BACKGROUND
  Rivastigmine is the only cholinesterase inhibitor (ChEI) available as transdermal patch. The patch was developed to improve gastrointestinal tolerability and treatment adherence to higher dosages as compared with oral medication. Preferences of patients and caregivers for the patch were reported; however, neither patient compliance nor caregiver burden has yet been measured under routine practice conditions.
  
  
  METHODS
  This was a prospective, multi-centre, observational study in patients with Alzheimer's disease treated with rivastigmine patch in Germany. To compare the transdermal with oral dosage forms, physicians were asked to enrol patients who recently switched from oral to transdermal medication. Beyond effectiveness and tolerability, outcome measures were drug adherence evaluated by the Morisky questionnaire, and caregiver burden, measured as the daily time expenditure for dressing the patient, controlling appearance and administration of medication.
  
  
  RESULTS
  In total, 1104 outpatients (57.5% female gender; mean age 77 ± 7 years) were enrolled in 220 sites. After 6 months of treatment, 67.5% of patients had an improved Clinical Global Impression and the Mini-Mental State Examination score increased from 19.0 ± 5.1 to 20.0 ± 5.2 (p < 0.001); 84.1% of patients were still on treatment, 64.6% on the target dose of 9.5 mg/day. Compliance and patient satisfaction with therapy continuously increased over the study period and average time savings of caregivers added up to 20 min/day. In general, tolerability was deemed good and there were no unexpected adverse events.
  
  
  CONCLUSIONS
  Transdermal rivastigmine is an effective treatment alternative, which may improve adherence and treatment satisfaction of the patient and relieve the caregiver. Controlled parallel-group trials are warranted.
  
  
  BACKGROUND
  none (observational study).
authors.affiliation: Institut für Studien zur Psychischen Gesundheit (ISPG), Mannheim, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Adler
authors.forename: B
authors.initials: B
authors.lastname: Mueller
authors.forename: K
authors.initials: K
authors.lastname: Articus
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy*; D017028:Caregivers; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D018696:Neuroprotective Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D000068836:Rivastigmine / Q000008:administration & dosage* / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D057968:Transdermal Patch; D016903:Drug Monitoring
chemical_list: D018696:Neuroprotective Agents; D000068836:Rivastigmine