Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-22T18:13:26.716Z Has data issue: false hasContentIssue false
  • English
  • Français

Continuous treatment with antidementia drugs in Germany 2003–2013: a retrospective database analysis

Published online by Cambridge University Press:  22 April 2015

Jens Bohlken ,
Simon Weber ,
Michael A. Rapp  and
Karel Kostev
Jens Bohlken
Affiliation:
Praxis Bohlken, Berlin, Germany
Simon Weber
Affiliation:
Charité Berlin, Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
Michael A. Rapp*
Affiliation:
Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
Karel Kostev
Affiliation:
Epidemiology & Evidence Based Medicine, Real World Evidence Solutions, IMS Health, Frankfurt, Germany
*
Correspondence should be addressed to: Michael A. Rapp, MD, PhD, Professor for Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, D-14469 Potsdam, Germany. Phone: +49 331 977 4095; Fax: +49 331 977 4078. Email: [email protected].
Get access

Abstract

Background:

Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics.

Methods:

Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan–Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status.

Results:

After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82–0.95) and memantine (HR: 0.85; 0.79–0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treated by specialist physicians as compared to general practitioners (HR: 0.44; 0.41–0.48). Younger male patients and patients who had private health insurance had a lower discontinuation risk. Regarding comorbidity, patients were more likely to be continuously treated with the index substance if a diagnosis of heart failure or hypertension had been diagnosed at baseline.

Conclusions:

Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment.

Keywords

Alzheimer’s diseasedementiatreatment continuationpersistenceadherencecholinesterase inhibitorsmemantine
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 8 , August 2015 , pp. 1335 - 1342
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abughosh, S. M. and Kogut, S. J. (2008). Comparison of persistence rates of acetylcholine-esterase inhibitors in a state Medicaid program. Patient Preference and Adherence, 2, 79–85.CrossRefGoogle Scholar
Amuah, J. E.et al. (2010). Persistence with cholinesterase inhibitor therapy in a population-based cohort of patients with Alzheimer's disease. Pharmacoepidemiology and Drug Safety, 19, 670–679.CrossRefGoogle Scholar
Arzneimittelkommission der deutschen Ärzteschaft [Drug Commission of the German Board of Physicians] (2001). Demenz. Arzneiverordnung in der Praxis. [Dementia. Prescription practices in primary care] Berlin: Arzneimittelkommission der deutschen Ärzteschaft [Drug Commission of the German Board of Physicians].Google Scholar
Becher, H., Kostev, K. and Schröder-Bernhardi, D. (2009). Validity and representativeness of the “Disease Analyzer” patient database for use in pharmacoepidemiological and pharmacoeconomic studies. International Journal of Clinical Pharmacology and Therapeutics, 47, 617–626.CrossRefGoogle ScholarPubMed
Birks, J. (2006). Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database of Systematic Reviews, 25, CD005593.Google Scholar
Brewer, L., Bennett, K., McGreevy, C. and Williams, D. (2013). A population-based study of dosing and persistence with anti-dementia medications. European Journal of Clinical Pharmacology, 69, 1467–1475.CrossRefGoogle ScholarPubMed
Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) [German Society for Psychiatry, Psychotherapie and Nervous Diseases] (2010). S3-Leitlinie “Demenzen.” [S3 guideline dementia]. (Available at: http://media.dgppn.de/mediadb/media/dgppn/pdf/leitlinien/s3-leitlinie-demenz-lf.pdf; last accessed 20.4.2010).Google Scholar
Doblhammer, G., Schulz, A., Steinberg, J. and Ziegler, U. (2012). Demografie der Demenz. [Demographics of dementia]. Bern, Verlag Hans Huber: Hogrefe AG.Google Scholar
Eichler, T.et al. (2014). Dementia care management: going new ways in ambulant dementia care within a GP-based randomized controlled intervention trial. International Psychogeriatrics, 26, 247–256.CrossRefGoogle ScholarPubMed
Fink, A. (2014). Dementia and long-term care – an analysis based on German health insurance data. In Doblhammer, G. (ed.), Health Among the Elderly in Germany: New Evidence on Disease, Disability and Care Need. Series on Population Studies by the Federal Institute for Population Research, 46 (pp. 109–126). Berlin, Toronto: Opladen.Google Scholar
Gill, S. S.et al. (2009). Syncope and its consequences in patients with dementia receiving cholinesterase inhibitors: a population-based cohort study. Archives of Internal Medicine, 169, 867–873.CrossRefGoogle ScholarPubMed
Haider, B., Schmidt, R., Schweiger, C., Forstner, T., Labek, A. and Lampl, C. (2014). Medication adherence in patients with dementia: an Austrian cohort study. Alzheimer Disease and Associated Disorders, 28, 128–133.CrossRefGoogle ScholarPubMed
Herrmann, N.et al. (2007). A population-based study of cholinesterase inhibitor use for dementia. Journal of the American Geriatrics Society, 55, 1517–1523.CrossRefGoogle ScholarPubMed
Hoffmann, F., Van den Bussche, H., Glaeske, G. and Kaduszkiewicz, H. (2010). Eight-year prescription trends of memantine and cholinesterase inhibitors among persons 65 years and older in Germany. International Clinical Psychopharmacology, 25, 29–36.CrossRefGoogle ScholarPubMed
Mauskopf, J. A., Paramore, C., Lee, W. C. and Snyder, E. H. (2005). Drug persistency patterns or patients treated with rivastigmine or donepezil in usual care settings. Journal of Managed Care Pharmacy, 11, 231–251.CrossRefGoogle ScholarPubMed
Maxwell, C. J., Stock, K., Seitz, D., Herrmann, N. (2014). Persistence and adherence with dementia pharmacotherapy: relevance of patient, provider, and system factors. Canadian Journal of Psychiatry, 59, 624–631.CrossRefGoogle ScholarPubMed
Motheral, B.et al. (2003). A checklist for retrospective database studies – Report from the ISPOR task force on retrospective databases. Value in Health, 6, 90–97.CrossRefGoogle ScholarPubMed
Mucha, L., Shaohung Wang, S., Cuffel, B., McRae, T., Mark, T. L. and del Valle, M. (2008). Comparison of cholinesterase inhibitor utilization patterns and associated health care costs in Alzheimer's disease. Journal of Managed Care Pharmacy, 14, 451–461.CrossRefGoogle ScholarPubMed
Ogdie, A., Langan, S., Parkinson, J., Dattani, H., Kostev, K. and Gelfand, J. M. (2012). Medical record databases. In Strom, B. L., Kimmel, S. and Hennessy, S., (eds.), Pharmacoepidemiology (pp. 224–243). Philadelphia, PA: University of Pennsylvania.CrossRefGoogle Scholar
Pariente, A., Pinet, M., Moride, Y., Merlière, Y., Moore, N. and Fourrier-Reglat, A. (2010). Factors associated with persistence of cholinesterase inhibitor treatments in the elderly. Pharmacoepidemiology and Drug Safety, 19, 680–686.CrossRefGoogle ScholarPubMed
Quan, H.et al. (2005). Coding algorithms for defining co-morbidities in ICD-9-CM and ICD-10 administrative data. Medical Care, 43, 1130–1139.CrossRefGoogle Scholar
Singh, G., Thomas, S. K., Arcona, S. K., Lingala, V. and Mithal, A. (2005). Treatment persistency with rivastigmine and donepezil in a large state Medicaid program. Journal of the American Geriatrics Society, 53, 1269–1270.CrossRefGoogle Scholar
Small, G. and Dubois, B. (2007). A review of compliance to treatment in Alzheimer's disease: potential benefits of a transdermal patch. Current Medical Research and Opinion, 23, 2705–2713.CrossRefGoogle ScholarPubMed
Suh, D. C., Thomas, S. K., Valiyeva, E., Arcona, S. and Vo, L. (2005). Drug persistency of two cholinesterase inhibitors: rivastigmine versus donepezil in elderly patients with Alzheimer's disease. Drugs & Aging, 22, 695–707.CrossRefGoogle ScholarPubMed
Swart, E. (2008). Good practice of secondary data analysis. First revision. Gesundheitswesen, 70, 54–60.Google Scholar
Taipalea, H., Tanskanene, A., Koponen, M., Tolppanen, A. M., Tiihonen, A. and Hartikainen, S. (2014). Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study. International Clinical Psychopharmacology, 29, 216–223.CrossRefGoogle Scholar
Turchin, A., Goldberg, S. I., Shabina, M., Einbinder, J. S. and Conlin, P. R. (2010). Encounter frequency and blood pressure in hypertensive patients with Diabetes. Hypertension, 56, 68–74.CrossRefGoogle ScholarPubMed
Van den Bussche, H. et al. (2011). Antidementia drug prescription sources and patterns after the diagnosis of dementia in Germany: results of a claims data-based 1-year follow-up. International Clinical Psychopharmacology, 26, 225–231.CrossRefGoogle Scholar
Vidal, J. S.et al. (2008). Memantine therapy for Alzheimer disease in real-world practice: an observational study in a large representative sample of French patients. Alzheimer Disease and Associated Disorders, 22, 125–130.CrossRefGoogle Scholar