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Effectiveness of switching to the rivastigmine transdermal patch from oral cholinesterase inhibitors: a naturalistic prospective study in Alzheimer’s disease

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Abstract

Oral donepezil and rivastigmine are two commonly used cholinesterase inhibitors (ChEIs) used in Alzheimer’s disease (AD). The rivastigmine transdermal patch formulation has high tolerability profile, allowing patients to achieve optimal therapeutic doses and providing potential advantages over oral ChEIs. This is a 6-month, multicentre, observational efficacy and tolerability study of switching from oral ChEIs to rivastigmine patch in AD patients who failed to show benefit from previous treatment. The reasons of the switch were: (1) lack/loss of benefit from previous oral ChEI treatment; (2) tolerability problems. The primary outcome was cognitive changes measured with the mini–mental state examination (MMSE) test. Secondary outcomes were modifications of functional independence and behavioral disturbances and occurrence of adverse events (AEs) after switching. 174 patients, over 180 patients screened, entered the study (lack/loss of efficacy: 57 %, tolerability problems: 33 %, both reasons: 10 %). 6 months after switching 56 % of patients stabilized or increased the MMSE score respect to baseline. The only predictor of this outcome was the response at 3 months. In the group with lack/loss of response to oral ChEI, the decline of the MMSE score changed from −3.4 ± 2.5 points in the 6 months before switching to −0.5 ± 3.2 in the 6 months after the switch (p < 0.001). There were no significant changes in the IADL or NPI scores. Drug discontinuation rate was 20 %, due to AEs (18 %) and lack of compliance (2 %). Switching from an unsuccessful oral ChEI therapy to rivastigmine patch is effective and safe in more than half of the switched patients after a 6-month period.

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Acknowledgments

The study was supported by the Department of Neurosciences, University of Padova, and by all the Memory Clinics participating to the study.

Conflict of interest

The authors have no financial conflict of interest.

Author information

Authors and Affiliations

  1. Department of Neurosciences SNPSRR, University of Padova Medical School, Via Giustiniani 5, 35128, Padova, Italy

    Annachiara Cagnin & Mario Ermani

  2. Foundation IRCCS San Camillo Hospital, Venice, Italy

    Annachiara Cagnin

  3. Department of Geriatric and Rehabilitation Medicine, Dolo Hospital, Dolo, VE, Italy

    Alberto Cester

  4. Neurology Division, Mater Salutis Hospital, Legnago, VR, Italy

    Bruno Costa

  5. CRIC, Medicine Clinic I, University Hospital of Padova, Padova, Italy

    Carlo Gabelli

  6. Alzheimer’s Center, Neuroscience Department, University Hospital of Verona, Verona, Italy

    Giuseppe Gambina

Authors
  1. Annachiara Cagnin
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  2. Alberto Cester
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  3. Bruno Costa
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  4. Mario Ermani
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  5. Carlo Gabelli
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  6. Giuseppe Gambina
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Consortia

SWITCH study working group

Corresponding author

Correspondence to Annachiara Cagnin.

Additional information

The all participants to the SWITCH study group are listed in the Appendix.

Appendix: list of participants of the SWITCH study and affiliations

Appendix: list of participants of the SWITCH study and affiliations

Ada Della Libera: Geriatric Division, Motta di Livenza Hospital, Motta di Livenza (VE), Italy.

Michela Marcon: Neurology Division, S. Bortolo Hospital, Vicenza (VI), Italy.

Bruno Costa: Neurology Division, Mater Salutis Hospital, Legnago (VR), Italy.

Enrico Vitale, Marino Formilan: Department of Geriatric and Rehabilitation Medicine, Noale-Dolo (VE) Italy.

Alessio Dalla Libera: Neurology Division, Hospital of Thiene, Thiene (VI), Italy.

Emilia Zanetti: Geriatric Division, Conegliano Hospital, Conegliano Veneto (TV), Italy.

Maria Cristina Mantovan: Neurology Clinic, Angel Hospital, Mestre (VE), Italy.

Paolo Spagnolli: Geriatric Division, Sacro Cuore - Don Calabria Hospital, Negrar (VR), Italy.

Anna Ceccon: Geriatric Division, Cittadella Hospital, Cittadella (PD), Italy.

Evelina Bianchi: Geriatric Division, S. Bortolo Hospital, Vicenza (VI), Italy.

Sara Pompanin: Department of Neurosciences SNPSRR, University of Padova, Padova (PD), Italy.

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Cagnin, A., Cester, A., Costa, B. et al. Effectiveness of switching to the rivastigmine transdermal patch from oral cholinesterase inhibitors: a naturalistic prospective study in Alzheimer’s disease. Neurol Sci 36, 457–463 (2015). https://doi.org/10.1007/s10072-014-2002-3

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  • DOI: https://doi.org/10.1007/s10072-014-2002-3

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