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Sex Differences in the Prevalent Use of Oral Formulations of Cholinesterase Inhibitors in Older Adults with Dementia

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Abstract

Background

Cholinesterase inhibitors (ChEIs) are one of only two drug therapies available to manage cognitive decline in dementia. Given sex-specific differences in medication access and effects, it is important to understand how ChEIs are used by women and men.

Objective

The objective of this study was to provide contemporary sex-stratified evidence on patterns of ChEI use by community-dwelling older adults with dementia to inform opportunities to optimize drug prescribing.

Methods

We conducted a population-based cross-sectional study examining ChEI use in older adults with dementia in Ontario, Canada. We identified all community-dwelling individuals aged 66 years and older with a pre-existing diagnosis of dementia as of 1 April, 2016. We examined the prevalence of ChEI use among women and men separately, and explored the association between ChEI use and age, sex, income status, geographic location of residence, use of palliative care services, comorbidity, and polypharmacy. Concurrent use of drugs known to impair cognition (including antipsychotics, benzodiazepines, and medications with strong anticholinergic properties) was separately assessed among women and men using multivariable analyses and prevalence risk ratios.

Results

Of 74,799 women and 52,231 men living with dementia in the community, nearly 30% currently were using a ChEI (29.3% women, 28.6% men). Close to 70% of users were receiving the target therapeutic dose. Compared to men, women were less often taking the target therapeutic dose (67.8% women vs. 71.6% men, p < 0.001). Over 20% of users also were using drugs known to impair cognition, while being treated for cognitive decline using ChEIs. Compared to men, women were more often concurrently using drugs known to impair cognition (23.9% women vs. 21.8% men, p < 0.001).

Conclusions

This is one of the first studies of ChEI use to account for important sex differences. The results remind clinicians and researchers that patterns of ChEI therapy use differ by sex, as women were less likely to receive target therapeutic doses and more vulnerable to potentially problematic polypharmacy than men.

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Acknowledgements

We thank IMS Brogan Inc. for use of their Drug Information Database. They had no role in the design, conduct, or reporting of the study, or in the decision to submit the manuscript for publication. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors, and not necessarily those of the Canadian Institute for Health Information.

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Authors and Affiliations

  1. Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada

    Lynn Zhu, Paula A. Rochon, Andrea Gruneir, Wei Wu, Vasily Giannakeas, Nathan M. Stall, Lisa McCarthy & Susan E. Bronskill

  2. Department of Medicine, University of Toronto, Room 2109, 1 King’s College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada

    Paula A. Rochon & Nathan M. Stall

  3. Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, 4th Floor, 155 College Street, Toronto, ON, M5T 3M6, Canada

    Paula A. Rochon, Peter C. Austin, Nathan M. Stall & Susan E. Bronskill

  4. ICES, G1 06, G-Wing, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Paula A. Rochon, Andrea Gruneir, Vasily Giannakeas, Peter C. Austin, Amanda Alberga, Sudeep S. Gill & Susan E. Bronskill

  5. Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada

    Andrea Gruneir

  6. Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S 3M2, Canada

    Lisa McCarthy

  7. Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada

    Lisa McCarthy

  8. Department of Psychiatry, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada

    Nathan Herrmann

  9. Department of Medicine, Queen’s University, Etherington Hall, Rooms 3032-3043, 94 Stuart Street, Kingston, ON, K7L 3N6, Canada

    Sudeep S. Gill

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  1. Lynn Zhu
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  11. Sudeep S. Gill
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  12. Susan E. Bronskill
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Corresponding author

Correspondence to Susan E. Bronskill.

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Funding

This study was supported by a grant from Physicians Services Incorporated (PSI 2015-16).The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. This study also was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. Paula A. Rochon is supported by the Retired Teachers of Ontario/ERO Chair in Geriatric Medicine at the University of Toronto. Peter C. Austin was supported by a Mid-Career Investigator Award from the Heart and Stroke Foundation.

Conflict of Interest

Lynn Zhu, Paula A. Rochon, Andrea Gruneir, Wei Wu, Vasily Giannakeas, Peter C. Austin, Nathan M. Stall, Lisa McCarthy, Amanda Alberga, Nathan Herrmann, Sudeep S. Gill, and Susan E. Bronskill have no conflicts of interest that are directly relevant to the contents of this article.

Ethics Approval

ICES is a prescribed entity under section 45 of Ontario’s Personal Health Information Protection Act. Section 45 authorizes ICES to collect personal health information, without consent, for the purpose of analysis or compiling statistical information with respect to the management of, evaluation or monitoring of, the allocation of resources to or planning for all or part of the health system. Projects conducted under section 45, by definition, do not require review by a research ethics board. This project was conducted under section 45, and approved by the ICES’ Privacy and Legal Office.

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Zhu, L., Rochon, P.A., Gruneir, A. et al. Sex Differences in the Prevalent Use of Oral Formulations of Cholinesterase Inhibitors in Older Adults with Dementia. Drugs Aging 36, 875–884 (2019). https://doi.org/10.1007/s40266-019-00690-9

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