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Drug Persistency of Two Cholinesterase Inhibitors

Rivastigmine versus Donepezil in Elderly Patients with Alzheimer’s Disease

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Abstract

Objectives

To compare persistency rates and persistency days in patients with Alzheimer’s disease (AD) who initiated therapy with either rivastigmine or donepezil, and to identify factors influencing persistency in a real-world setting.

Design and methods

This study used data collected by MarketScan® from 1 January 1999 to 31 December 2002. Patients were included if they were newly diagnosed with AD and filled at least one prescription for rivastigmine or donepezil between 1 July 2000 and 30 June 2001, were ≥65 years of age on the index prescription date, and had continuous health and prescription insurance during the entire study period. Patients were excluded if they filled a prescription for any cholinesterase inhibitor during the 18 months prior to initiation of the study drugs. Patients who refilled their initial cholinesterase inhibitor prescription within a permissible gap of 60 days after depleting the drug supply from the prior prescription were considered to be persistent. Sensitivity analysis was performed to test the robustness of the persistency definition. The Kaplan-Meier method was used to determine persistency rates across time and Cox proportional hazards models were used to estimate relative risks of discontinuation or switch with adjustment for other covariates, and to identify factors significantly influencing persistency of the study drugs.

Results

Of the newly treated AD patients, the proportion of rivastigmine and donepezil patients who continued their medication was the same (47%; p = 0.5). On average, rivastigmine users continuously used their medication for 234 days (median 312 days) while those taking donepezil used their medication for 235 days (median 315 days) [p = 0.91]. Patients were more likely to discontinue or switch their initial cholinesterase inhibitor if they used a central nervous system (CNS) medication before initiation of therapy (relative risk [RR] = 1.23; 95% CI 1.01, 1.51 without adjustment for study variables; RR = 1.30; 95% CI 1.05, 1.60 with adjustment for study variables). On the other hand, patients were less likely to discontinue their cholinesterase inhibitor if they visited their physician office frequently (RR = 0.24; 95% CI 0.18, 0.32 without adjustment; RR = 0.23; 95% CI 0.17, 0.30 with adjustment) or if they were hospitalised after initiation of their cholinesterase inhibitor therapy (RR = 0.60; 95% CI 0.39, 0.91 without adjustment; RR = 0.65; 95% CI 0.42, 0.99 with adjustment).

Conclusion

Patients who were newly diagnosed with AD and initiated therapy with either rivastigmine or donepezil had similar levels of persistency with their initial AD therapy in a real-world setting.

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Acknowledgements

The study was partially funded by an unrestricted research grant from Novartis Pharmaceuticals Corporation.

The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Mario School of Pharmacy, Rutgers University, 160 Frelinghuysen Road, Piscataway, New Jersey, 08854, USA

    Dong-Churl Suh, Elmira Valiyeva & Lien Vo

  2. Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA

    Simu K. Thomas & Stephen Arcona

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  1. Dong-Churl Suh
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  2. Simu K. Thomas
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Correspondence to Dong-Churl Suh.

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Suh, DC., Thomas, S.K., Valiyeva, E. et al. Drug Persistency of Two Cholinesterase Inhibitors. Drugs Aging 22, 695–707 (2005). https://doi.org/10.2165/00002512-200522080-00006

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