title: Efficacy of Galantamine on Cognition in Mild-to-Moderate Alzheimer's Dementia after Failure to Respond to Donepezil.
abstract: OBJECTIVE
  This study compares the efficacy of the cholinesterase inhibitor (ChEI) galantamine on cognition in patients with mild-to-moderate Alzheimer's dementia (AD) who were either naïve to ChEI drugs or who had failed a trial of the ChEI donepezil.
  
  
  METHODS
  Outpatients with AD were sequentially referred for screening and enrollment. Current outpatients who had taken donepezil for at least 6 months without demonstrated efficacy on cognition were switched to galantamine (switched group). New outpatients with no ChEI prescription history were classified as the naïve group and were given galantamine. The primary outcome measures for the between-group comparison were response rate on cognition at 26 and 52 weeks (categorical) and change on the Korean version of the Alzheimer's Disease Assessment Scale-cognitive subscale (dimensional). Secondary cognitive outcomes were measured using the subset of frontal executive function and the Korean Mini-Mental State Examination.
  
  
  RESULTS
  Seventy outpatients were enrolled and 66 were analyzed by Intent-to-treat (ITT). There were 42 cases in the naïve group and 24 in the switched group. Response rates did not differ at 26 weeks (71.4% naïve vs. 58.3% switched; p=0.277) or at 52 weeks (59.5% naïve vs. 41.6% switched; p=0.162). No significant differences were observed in the pattern of change over the 52 weeks on the primary and secondary cognitive scales.
  
  
  CONCLUSIONS
  As the efficacy of galantamine on cognition was not inferior in the switched group compared to that in the naïve group, switching ChEI drugs is clinically feasible for non-responding patients with mild-to-moderate AD.
authors.affiliation: Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.; Department of Psychiatry, Jeonbuk Provincial Maeumsarang Hospital, Wanju, Republic of Korea.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Hwang
authors.affiliation: Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea.
authors.forename: Inn-Sook
authors.initials: IS
authors.lastname: Ahn
authors.affiliation: Biostatistics Unit, Samsung Biomedical Research Institute, Seoul, Republic of Korea.
authors.forename: Seonwoo
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.; Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea.
authors.forename: Doh Kwan
authors.initials: DK
authors.lastname: Kim
keywords: Alzheimer's dementia; Cognition; Donepezil; Efficacy; Galantamine; Switching