Donepezil is associated with delayed nursing home placement in patients with Alzheimer's disease

被引:196
作者
Geldmacher, DS
Provenzano, G
McRae, T
Mastey, V
Ieni, JR
机构
[1] Pfizer Inc, Alzheimers Dis Management Team, Pfizer Pharmaceut Grp, New York, NY 10017 USA
[2] Univ Hosp Res Inst, Univ Memory & Aging Ctr, Cleveland, OH USA
[3] Case Western Reserve Univ, Cleveland, OH 44106 USA
[4] Batelle, Ctr Publ Hlth Res & Evaluat, Arlington, VA USA
[5] Pfizer Inc, Outcomes Res, New York, NY 10017 USA
[6] Eisai Inc, Med Affairs, Teaneck, NJ USA
关键词
Alzheimer's disease; donepezil; cholinesterase inhibitor; nursing home placement;
D O I
10.1046/j.1365-2389.2003.51306.x
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
OBJECTIVES: To assess the relationship between donepezil treatment and time to nursing home placement (NHP) for patients with Alzheimer's disease (AD). DESIGN: Observational follow-up of patient NHP and vital status. SETTING: Community. PARTICIPANTS: Patients previously enrolled in one of three randomized, double-blind, placebo-controlled clinical trials of donepezil and two subsequent open-label studies (total N = 1,115); 671 patients provided complete data for analysis. MEASUREMENTS: Data were obtained through follow-up interviews with caregivers and chart reviews of patients with AD. Comparison groups were defined by whether patients received an effective dose of donepezil (greater than or equal to5 mg/d; greater than or equal to80% compliance) for specific numbers of weeks during the double-blind or open-label trial phase, in both phases, or in neither. Cox proportional hazards models were used to estimate risk ratios for NHP and survival curves from which median times to NHP were estimated for first dementia-related placement of longer than 2 weeks and permanent placement. The models were adjusted for age, sex, baseline Mini-Mental State Examination score, whether the caregiver was a spouse, caregiver continuity, and use of other cholinesterase inhibitors after the clinical trials. RESULTS: Use of donepezil of 5 mg/d or more was associated with significant delays in NHP. A cumulative dose-response relationship was observed between longer-term sustained donepezil use and delay of NHP. When donepezil was taken at an effective dose for at least 9 to 12 months, conservative estimates of the time gained before NHP were 21.4 months for first dementia-related NHP and 17.5 months for permanent NHP. CONCLUSION: Use of donepezil by AD patients resulted in significant delays in NHP. Long-term use of donepezil may help AD patients live longer in community settings, with consequent personal, social, and economic benefits.
引用
收藏
页码:937 / 944
页数:8
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