Real-world evaluation of compliance and preference in Alzheimer's disease treatment: an observational study in Taiwan.
OBJECTIVE
Among the medications approved for Alzheimer's disease (AD), rivastigmine is the only one available as transdermal patch. The aim of this study was to evaluate compliance and caregivers' preference with oral and transdermal (rivastigmine) monotherapy in patients with mild-to-moderate AD from Taiwan.


METHODS
Real-world Evaluation of Compliance And Preference in Alzheimer's disease treatment (RECAP) in Taiwan was a prospective, noninterventional, observational study with a 24-week (±8 weeks) observational period for each participant. Eligible patients were grouped into one of the two treatment cohorts based on the baseline AD therapy: oral (donepezil, galantamine, rivastigmine, or memantine) or transdermal (rivastigmine patch). The primary end points were caregiver preference and caregiver assessment of patients' compliance to the current medication (oral or transdermal medication) at Week 24 (end of the study). Safety was assessed by recording any adverse events.


RESULTS
A total of 301 patients (age: 77.6±7.19 years) were enrolled from nine centers in Taiwan, of whom 138 (45.8%) patients were in the transdermal monotherapy cohort. Caregivers of patients who were exposed to both forms of therapies demonstrated a higher preference for transdermal rivastigmine monotherapy than the oral monotherapy (82.4% [n=61] versus 17.6% [n=13], P<0.0001); for patients treated with only one therapy, the caregivers' preference was significantly in favor of the treatment to which the patient was exposed (both P<0.0001). In both cohorts, patients showed good compliance, with an overall score of 8.65±1.38 on an 11-point scale. Of 301 enrolled patients, 102 (33.9%) reported at least one adverse event during the study (51 patients each in the two cohorts).


CONCLUSIONS
With the higher caregiver preference and a good patient compliance, the trans-dermal rivastigmine patch is a suitable treatment choice for patients with mild-to-moderate AD, especially for patients intolerant to oral therapies.
Section of Neurology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan; Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Tzu-Hsien
TH
Lai
Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
Wen-Fu
WF
Wang
Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Bak-Sau
BS
Yip
Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
Yu-Wan
YW
Yang
Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Giia-Sheun
GS
Peng
Department of Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Shih-Jei
SJ
Tsai
Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
Yi-Chu
YC
Liao
Division of Behavioral Neurology, Department of Neurology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; Alzheimer's Disease Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
Ming-Chyi
MC
Pai
Alzheimer’s disease; caregiver preference; cholinesterase inhibitors; observational study; patient compliance; rivastigmine