title: Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study.
abstract: The objective of this study was to investigate the prevalence of acetylcholinesterase inhibitor (AChEI) and memantine use, duration of treatment, concomitant use of these drugs, and factors associated with the discontinuation of AChEI therapy during 2006-2009. We utilized data from a nationwide sample of community-dwelling individuals with a clinically verified Alzheimer's disease diagnosed during the year 2005 (n=6858) as a part of the MEDALZ-2005 study. During the 4-year follow-up, 84% used AChEI and 47% used memantine. Altogether, 22% of the sample used both drugs concomitantly. The median duration of the first AChEI use period was 860 (interquartile range 295-1458) days and 1103 (interquartile range 489-1487) days for the total duration of AChEI use. Although 20% of the AChEI users discontinued the use during the first year, over half of them restarted later. The risk of discontinuation was higher for rivastigmine [hazard ratio 1.34 (confidence interval 1.22-1.48)] and galantamine users [hazard ratio 1.23 (confidence interval 1.15-1.37)] compared with donepezil users in the adjusted model. In conclusion, median time for AChEI use was over 3 years and every fifth Alzheimer's disease patient used AChEI and memantine concomitantly during the follow-up. The low rate of discontinuation is consistent with the Finnish Care Guideline but in contrast to the results reported from many other countries.
authors.affiliation: aKuopio Research Centre of Geriatric Care bSchool of Pharmacy cResearch Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland dDepartment of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio eNational Institute for Health and Welfare, Helsinki, Finland fDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Heidi
authors.initials: H
authors.lastname: Taipale
authors.forename: Antti
authors.initials: A
authors.lastname: Tanskanen
authors.forename: Marjaana
authors.initials: M
authors.lastname: Koponen
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Tolppanen
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D000077265:Donepezil; D016903:Drug Monitoring; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination / Q000009:adverse effects; D018691:Excitatory Amino Acid Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D005702:Galantamine / Q000009:adverse effects / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D007189:Indans / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008559:Memantine / Q000009:adverse effects / Q000627:therapeutic use*; D018697:Nootropic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D048448:Phenylcarbamates / Q000009:adverse effects / Q000627:therapeutic use; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012042:Registries; D000068836:Rivastigmine
chemical_list: D002800:Cholinesterase Inhibitors; D018691:Excitatory Amino Acid Antagonists; D007189:Indans; D018697:Nootropic Agents; D048448:Phenylcarbamates; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine; D008559:Memantine