title: Clinical Recommendations for the Use of Donepezil 23 mg in Moderate-to-Severe Alzheimer's Disease in the Asia-Pacific Region.
abstract: BACKGROUND
  The 'Asia-Pacific Expert Panel (APEX) for donepezil 23 mg' met in November 2015 to review evidence for the recently approved high dose of donepezil and to provide recommendations to help physicians in Asia make informed clinical decisions about using donepezil 23 mg in patients with moderate-to-severe Alzheimer's disease (AD).
  
  
  CONCLUSIONS
  In a global phase III study (study 326) in patients with moderate-to-severe AD, donepezil 23 mg/day demonstrated significantly greater cognitive benefits versus donepezil 10 mg/day, with a between-treatment difference in mean change in the Severe Impairment Battery score of 2.2 points (p < 0.001) in the overall population and 3.1 points (p < 0.001) in patients with advanced AD. A subanalysis of study 326 demonstrated that the benefits and risks associated with donepezil 23 mg/day versus donepezil 10 mg/day in Asian patients with moderate-to-severe AD were comparable to those in the global study population.
  
  
  CONCLUSIONS
  Donepezil 23 mg is a valuable treatment for patients with AD, particularly those with advanced disease. The APEX emphasized the importance of patient selection (AD severity, tolerability of lower doses of donepezil, and absence of contraindications), a stepwise titration strategy for dose escalation, and appropriate monitoring and counseling of patients and caregivers in the management of patients with AD.
authors.affiliation: Alzheimer's and Memory Disorders Division, Barrow Neurological Institute, Phoenix, Ariz., USA.
authors.forename: Marwan
authors.initials: M
authors.lastname: Sabbagh
authors.affiliation: Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: SeolHeui
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Neurology, Neurocognitive Behavior Center of Seoul National University Bundang Hospital, Seoul, Republic of Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: SangYun
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Neurology, Bobath Memorial Hospital, Seongnam, Republic of Korea.
authors.forename: Hae-Ri
authors.initials: HR
authors.lastname: Na
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Jae-Hong
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Neurology, National Neuroscience Institute and Duke-NUS Medical School, Singapore.
authors.forename: Nagaendran
authors.initials: N
authors.lastname: Kandiah
authors.affiliation: Division of Neurology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Kammant
authors.initials: K
authors.lastname: Phanthumchinda
authors.affiliation: Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
authors.forename: Chuthamanee
authors.initials: C
authors.lastname: Suthisisang
authors.affiliation: Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Vorapun
authors.initials: V
authors.lastname: Senanarong
authors.affiliation: Division of Behavioral Neurology, Department of Neurology, Medical College and Hospital, National Cheng Kung University, Tainan City, Taiwan, ROC.
authors.forename: Ming-Chyi
authors.initials: MC
authors.lastname: Pai
authors.affiliation: Department of Neurology, Medicine Faculty University of Indonesia, CiptoMangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Diatri
authors.initials: D
authors.lastname: Narilastri
authors.affiliation: SAL Hospital, Ahmedabad, India.
authors.forename: Ajit M
authors.initials: AM
authors.lastname: Sowani
authors.affiliation: University of Santo Tomas Hospital, Manila, Philippines.
authors.forename: Encarnita
authors.initials: E
authors.lastname: Ampil
authors.affiliation: Eisai Pharmaceuticals India Pvt. Ltd., Mumbai, India.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Dash
keywords: Acetylcholinesterase inhibitors; Aging; Alzheimer's disease; Dementia; Disease progression; Donepezil; Dose-response relationship