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Trends in the Prescription and Long-Term Utilization of Antidementia Drugs Among Patients with Alzheimer’s Disease in Spain: A Cohort Study Using the Registry of Dementias of Girona

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Abstract

Background

Acetylcholinesterase inhibitors (AChEIs) and the N-methyl d-aspartate-antagonist memantine are indicated for the symptomatic treatment of Alzheimer’s disease (AD).

Objectives

Our aims were to describe the baseline characteristics of patients with AD according to prescription of these treatments after the diagnostic work-up to describe long-term trends in the use of these medications and to identify baseline characteristics associated with the frequency of use of each treatment.

Methods

This was a cohort study with a sample of 2992 patients with AD recorded in the Registry of Dementias of Girona (ReDeGi) between 2007 and 2014. Consumption of AChEIs and memantine was assessed using the Pharmacy Unit database from the Public Catalan Healthcare Service. We used generalized estimating equation analyses to identify the baseline characteristics associated with the consumption of AChEIs and memantine over time.

Results

Most of the patients (70.4%; 95% confidence interval [CI] 68.7–72.0) were prescribed antidementia medication at the time of diagnosis. Of these, 75.0% (95% CI 73.1–76.8) were prescribed AChEIs, 14.7% (95% CI 13.2–16.3) were prescribed an AChEI plus memantine, and 10.3% (95% CI 9.0–11.6) were prescribed memantine. Advanced age reduced the likelihood of AChEI consumption. Mild dementia severity increased the use of AChEIs, and moderate–advanced dementia increased the likelihood of memantine consumption. After diagnosis, the likelihood of AChEI consumption decreased from the first year until the fifth, whereas the likelihood of memantine consumption, either alone or in combination with AChEIs, increased.

Conclusions

Antidementia drug use in this study showed the initial use of AChEIs alone with later use of AChEIs in combination with memantine and memantine alone in older patients with severe AD. Our findings are in agreement with current clinical practice guidelines for the pharmacological treatment of AD.

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Acknowledgements

The REDEGI Group consists of the following investigators: Department of Neurology, Hospital Universitari Josep Trueta: Jordi Gich; Albert Molins; Lluís Ramió; Joaquín Serena; Yolanda Silva, Mikel Terceño, René Robles. Dementia Unit, Hospital Santa Caterina: Marta Hernández; Manuela Lozano; Immaculada Pericot; Joan Vilalta-Franch; Antoni Turon Estrada; Jordi Llinàs; Secundino López-Pousa, Berta Solano, Mikel Terceño. Dementia Unit, Serveis de Salut Integrats del Baix Empordà: Elisabet Alsina; Rosa de Eugenio; Erélido Hernández; Margarita Flaqué. Neurology Department, Hospital de Figueres: Olga Carmona; Marta Cullell; Teresa Osuna; Mª del Mar Fernández. Neurology and Geriatrics Departments, Hospital d’Olot: Josep Bisbe; Marta Linares; Fabian Marquez Daniel; Natalia Vallmajó. Neurology and Geriatrics Departments, Hospital de Blanes: Héctor Perkal; Marta Viñas. Neurology Department; Hospital de Campdevànol: Isabel Casas; Josefa Turbau; Josep Mª Cuy; Anna Manzano. Pharmacy Unit, Health Region of Girona: Anna Maria Roig; Joan Coromina; Mònica Palacios Soto.

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Authors and Affiliations

  1. Girona Biomedical Research Institute (IdIBGI), C/Dr. Castany, s/n, Salt, 17190, Girona, Catalonia, Spain

    Laia Calvó-Perxas, Oriol Turró-Garriga, Joan Vilalta-Franch & Josep Garre-Olmo

  2. Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain

    Oriol Turró-Garriga, Joan Vilalta-Franch, Manuela Lozano-Gallego & Josep Garre-Olmo

  3. Department of Medicine, University of Girona, Girona, Catalonia, Spain

    Joan Vilalta-Franch & Josep Garre-Olmo

  4. Dementia Unit, Hospital de Palamós, Palamós, Catalonia, Spain

    Rosa de Eugenio

  5. Neurology Department, Hospital d’Olot, Olot, Catalonia, Spain

    Fabián Márquez

  6. Neurology Unit, Hospital de Figueres, Figueres, Catalonia, Spain

    Olga Carmona

  7. Neurodegenerative Disease Unit, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain

    Jordi Gich

  8. Neurology Department, Hospital de Campdevànol, Campdevànol, Catalonia, Spain

    Anna Manzano

  9. Geriatrics and Neurology Department, Hospital de Blanes, Blanes, Catalonia, Spain

    Marta Viñas

  10. Pharmacy Unit, Health Region of Girona, Girona, Catalonia, Spain

    Anna Mª Roig

Authors
  1. Laia Calvó-Perxas
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  2. Oriol Turró-Garriga
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  3. Joan Vilalta-Franch
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  4. Manuela Lozano-Gallego
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  5. Rosa de Eugenio
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  6. Fabián Márquez
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  7. Olga Carmona
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  8. Jordi Gich
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  9. Anna Manzano
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  10. Marta Viñas
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  11. Anna Mª Roig
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  12. Josep Garre-Olmo
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Consortia

on behalf of the Registry of Dementias of Girona Study Group (ReDeGi Study Group)

  • Jordi Gich
  • , Albert Molins
  • , Lluís Ramió
  • , Joaquín Serena
  • , Yolanda Silva
  • , Mikel Terceño
  • , René Robles
  • , Marta Hernández
  • , Manuela Lozano
  • , Immaculada Pericot
  • , Joan Vilalta-Franch
  • , Antoni Turon Estrada
  • , Jordi Llinàs
  • , Secundino López-Pousa
  • , Berta Solano
  • , Mikel Terceño
  • , Elisabet Alsina
  • , Rosa de Eugenio
  • , Erélido Hernández
  • , Margarita Flaqué
  • , Olga Carmona
  • , Marta Cullell
  • , Teresa Osuna
  • , Mª del Mar Fernández
  • , Josep Bisbe
  • , Marta Linares
  • , Fabian Marquez Daniel
  • , Natalia Vallmajó
  • , Héctor Perkal
  • , Marta Viñas
  • , Isabel Casas
  • , Josefa Turbau
  • , Josep Mª Cuy
  • , Anna Manzano
  • , Anna Maria Roig
  • , Joan Coromina
  •  & Mònica Palacios Soto

Corresponding author

Correspondence to Josep Garre-Olmo.

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Funding

The ReDeGi is funded by the Health Region of Girona from the Department of Health of the Generalitat de Catalunya (Spain). This work was funded by Eli Lilly and Company. The funding source had no involvement in the decision to submit the paper for publication.

Conflict of interest

Laia Calvó-Perxas, Oriol Turró-Garriga, Joan Vilalta-Franch, Manuela Lozano-Gallego, Rosa de Eugenio, Fabián Márquez, Olga Carmona, Jordi Gich, Anna Manzano, Marta Viñas, Anna Mª Roig, Josep Garre-Olmo have no conflicts of interest.

Ethical approval

No formal consent is required for this type of study. The ReDeGi meets the confidentiality requirements of Spanish legislation.

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Calvó-Perxas, L., Turró-Garriga, O., Vilalta-Franch, J. et al. Trends in the Prescription and Long-Term Utilization of Antidementia Drugs Among Patients with Alzheimer’s Disease in Spain: A Cohort Study Using the Registry of Dementias of Girona. Drugs Aging 34, 303–310 (2017). https://doi.org/10.1007/s40266-017-0446-x

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  • DOI: https://doi.org/10.1007/s40266-017-0446-x

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