An open-label, comparative study of rivastigmine, donepezil and galantamine in a real-world setting

Aguglia, Eugenio; Onor, Maria Luisa; Saina, M.; Maso, E.

doi:10.1185/030079904x6273

Cited by 44 publications

(29 citation statements)

References 10 publications

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“…In terms of cognitive function and functionality of treated patients, some studies have shown similar results among the 3 ChEIs [33,37,38] , while other studies have shown a significant advantage for one of them: rivastigmine [36,39,40] , galantamine [34] or donepezil [35,40] . However, no strict comparisons have been done with memantine.…”

Section: Discussionmentioning

confidence: 85%

Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Sevilla

Caballero²,

Alfonso³

et al. 2009

Dement Geriatr Cogn Disord

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Background/Aims: A full comparison of the satisfaction with treatment using the current Alzheimer’s disease (AD) therapies from the perspective of caregivers has not yet been done. The aim of this study was thus to find out the degree of satisfaction with the main available drug treatments in monotherapy for AD from this point of view. Methods: A cross-sectional, multicentre study of patients with possible/probable AD according to DSM-IV/NINCDS-ADRDA criteria, on monotherapy with donepezil, galantamine, rivastigmine or memantine, was carried out. Treatment satisfaction was measured by a caregiver proxy-administration of the generic SATMED-Q questionnaire [range: 0 (not satisfied at all) to 100 (totally satisfied)], overall and in 6 domains: tolerability, efficacy, medical care, ease and convenience, impact on daily activities and overall satisfaction. Results: A total of 829 patients were included: 63.3% women, aged 78.2 ± 6.8 years; 546 (67.3%) on donepezil, 106 (13.1%) on rivastigmine, 99 (12.2%) on galantamine and 60 (7.4%) on memantine. SATMED-Q scores p values were adjusted by MMSE and treatment duration. Caregivers of patients on donepezil showed significantly higher SATMED-Q total (71.8 ± 12.3; p < 0.05) and overall satisfaction domain scores (81.6 ± 18.4; p < 0.01) than those of patients on any other drugs, as well as significantly higher ease and convenience of use domain (81.5 ± 17.4; p < 0.01) and undesirable effects domain (96.0 ± 12.9; p < 0.05) scores than those of rivastigmine- and galantamine-treated patients. Of the caregivers of donepezil-treated patients, 76.7% were satisfied with treatment versus 68.7, 61.4 and 46.7% of those caregivers whose patients were treated with galantamine, rivastigmine and memantine, respectively (p = 0.0002). Conclusion: Caregivers of AD patients undergoing donepezil monotherapy seem to be more satisfied with treatment than those of patients receiving the other usual AD treatments in this study, particularly due to the ease and convenience of use of this drug. The higher level of satisfaction of these caregivers could be explained by the fact that, within the donepezil group, a high percentage of patients were treated with orally disintegrating tablets, which are easier for the patient to swallow.

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Section: Discussionmentioning

confidence: 85%

Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Sevilla

Caballero²,

Alfonso³

et al. 2009

Dement Geriatr Cogn Disord

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“…However, very few and not conclusive comparative clinical trials have been performed with the different AChEIs currently used to treat Alzheimer's disease. The study by Aguglia et al (2004) is the first to compare the effects of donepezil, rivastigmine, and galantamine on the Mini-Mental State Examination, Alzheimer's Disease Assessment Scale-cogntive subscale, Instrumental Activities of Daily Living, and Activities of Daily Living; however, limitations of the study included its small population size, its open-label design, and the fact that patients were randomized only after the introduction of galantamine. The results of this study showed no statistical significant differences between the three drugs at 3 months, although numerical trends were observed that suggested the effect of rivastigmine Ͼ donepezil Ͼ galantamine.…”

Section: Discussionmentioning

confidence: 99%

Unequal Neuroprotection Afforded by the Acetylcholinesterase Inhibitors Galantamine, Donepezil, and Rivastigmine in SH-SY5Y Neuroblastoma Cells: Role of Nicotinic Receptors

Arias

Gallego-Sandı́n²,

Villarroya³

et al. 2005

J Pharmacol Exp Ther

154

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Donepezil, rivastigmine, and galantamine are three drugs with acetylcholinesterase (AChE)-inhibiting activity that are currently being used to treat patients suffering from Alzheimer's disease. We have studied the neuroprotective effects of these drugs, in comparison with nicotine, on cell death caused by ␤-amyloid (A␤) and okadaic acid, two models that are relevant to Alzheimer's pathology, in the human neuroblastoma cell line SH-SY5Y. Galantamine and donepezil showed a U-shaped neuroprotective curve against okadaic acid toxicity; maximum protection was achieved at 0.3 M galantamine and at 1 M donepezil; at higher concentrations, protection was diminished. Rivastigmine showed a concentration-dependent effect; maximum protection was achieved at 3 M. When apoptosis was induced by A␤ [25][26][27][28][29][30][31][32][33][34][35] , galantamine, donepezil, and rivastigmine showed maximum protection at the same concentrations: 0.3, 1, and 3 M, respectively. Nicotine also afforded protection against A␤-and okadaic acid-induced toxicity. The neuroprotective effects of galantamine, donepezil, and nicotine were reversed by the ␣7 nicotinic antagonist methyllycaconitine but not by the ␣4␤2 nicotinic antagonist dihydro-␤-erythroidine. The phosphoinositide 3-kinase (PI3K)-Akt blocker 2-(4-morpholinyl)-8-phenyl-1(4H)-benzopyran-4-one hydrochloride (LY294002) reversed the protective effects of galantamine, donepezil, and nicotine but not that of rivastigmine. In contrast, the bcl-2 antagonist ethyl[2-amino-6-bromo-4-(1-cyano-2-ethoxy-2-oxoethyl)]-4H-chromene-3-carboxylate (HA 14-1) reversed the protective effects of the three AChE inhibitors and that of nicotine. Our results show that galantamine, donepezil, and rivastigmine afford neuroprotection through a mechanism that is likely unrelated to AChE inhibition. Such neuroprotection seemed to be linked to ␣7 nicotinic receptors and the PI3K-Akt pathway in the case of galantamine and donepezil but not for rivastigmine.Alzheimer's disease (AD) is a progressive neurodegenerative disease and the most common form of dementia in the elderly population. Clinically, patients with AD show progressive deterioration of all cognitive functions, resulting in their incapacitation. AD is characterized by the presence of two kinds of abnormal protein deposits, amyloid plaques and neurofibrillary tangles (NFTs) in specific areas of the brain, and finally by the atrophy of the affected brain regions, which results from extensive losses of synapses and neurons (Terry et al., 1981(Terry et al., , 1991Price et al., 1991;Arriagada et al., 1992). Amyloid plaques are extracellular deposits containing ␤-amyloid peptide (A␤) as the major core deposits. A␤ is a 39-to 43-amino acid peptide fragment derived through proteolysis from an integral membrane protein known as A␤ precursor protein. The basis for the ␤-amyloid hypothesis arises from various studies showing that A␤ is toxic to neurons; for example, there is increased A␤ release and apoptotic cell

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“…Four of the six prospective studies reported data from the CRONOS project, a national project initiated by the Italian government in October 2000 [26,27,31,32] . The project involved 503 Alzheimer evaluation units (AEUs) and aimed to standardise ChEI prescriptions and to assess their effects on defined outcomes (cognition, functional status, behaviour) in non-selected subjects with mild to moderate AD [35] .…”

Section: Prospective Study Characteristicsmentioning

confidence: 99%

“…The project involved 503 Alzheimer evaluation units (AEUs) and aimed to standardise ChEI prescriptions and to assess their effects on defined outcomes (cognition, functional status, behaviour) in non-selected subjects with mild to moderate AD [35] . No restrictions on which ChEI was prescribed were applied in 3 of the 4 studies [26,27,31,32] , although galantamine only became available for treatment from April 2001 onwards. However, in the study by Aguglia et al [31] , treatment was assigned in a pseudo-randomised fashion based on arrival at the AEU following the availability of galantamine.…”

Section: Prospective Study Characteristicsmentioning

confidence: 99%

Safety and Tolerability of Donepezil, Rivastigmine and Galantamine for Patients with Alzheimer’s Disease: Systematic Review of the ‘Real-World’ Evidence

Lockhart

Mitchell

Kelly

2009

Dement Geriatr Cogn Disord

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Background/Aims: The purpose of this systematic review was to compare the safety and tolerability of the cholinesterase inhibitors (ChEIs) donepezil, rivastigmine and galantamine for treating mild to moderate Alzheimer’s disease (AD) patients in routine clinical practice. Methods: Electronic databases (Cochrane Library, Medline, EMBASE; accessed October 2008) and manual bibliographic searches were conducted to identify head-to-head non-randomised studies examining ChEIs for the treatment of AD. Data were extracted by 2 independent reviewers. Results: Twelve head-to-head studies comparing ChEIs met the pre-specified inclusion criteria; 6 retrospective analyses and 6 prospective cohort studies. Donepezil was the most widely studied treatment and galantamine the least widely prescribed therapy. Fewer donepezil-treated subjects withdrew due to adverse events (AEs) compared with rivastigmine and galantamine-treated subjects. The incidence of gastrointestinal (GI) AEs was lower following treatment with donepezil compared with rivastigmine and galantamine. Non-GI (CNS and cardiovascular) AEs occurred at a low frequency, and had a similar incidence in subjects treated with the different ChEIs. Conclusions: Subjects with mild to moderate AD treated in routine clinical practice with donepezil were more adherent to pharmacotherapy, and had a lower risk of GI AEs compared with rivastigmine or galantamine. This finding accords with results reported in the randomised clinical trial literature.

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An open-label, comparative study of rivastigmine, donepezil and galantamine in a real-world setting

Cited by 44 publications

References 10 publications

Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Current Treatments of Alzheimer Disease: Are Main Caregivers Satisfied with the Drug Treatments Received by Their Patients?

Unequal Neuroprotection Afforded by the Acetylcholinesterase Inhibitors Galantamine, Donepezil, and Rivastigmine in SH-SY5Y Neuroblastoma Cells: Role of Nicotinic Receptors

Safety and Tolerability of Donepezil, Rivastigmine and Galantamine for Patients with Alzheimer’s Disease: Systematic Review of the ‘Real-World’ Evidence

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