Persistence and adherence to rivastigmine in patients with dementia: Results from a noninterventional, retrospective study using the National Health Insurance research database of Taiwan

Abstract

IntroductionThe objective of the study was to assess adherence and persistence of patients treated with rivastigmine versus donepezil.MethodsPersistence was calculated as the time from the first prescription date of rivastigmine/donepezil until discontinuation/medication switch/end of available data, whichever occurred first. Adherence was calculated as proportion of days covered and medication possession ratio.ResultsA majority of patients persisted on 4.5 and 6 mg of rivastigmine for 429 and 468 days, respectively, versus 443 and 441 days for patients receiving 5 and 10 mg of donepezil daily, respectively. Patients who initially received 1.5 mg of oral rivastigmine required a shorter time to reach a stable dose compared with those who initiated treatment at a higher dose of rivastigmine. Patients at a stable dose of 4.5 or 6 mg of rivastigmine were observed to persist longer than those at a lower dose of rivastigmine and donepezil.DiscussionAlthough results indicate significant difference in persistence between rivastigmine and donepezil groups, clinical significance remains undetermined.

Cholinesterase inhibitors for the treatment of dementia: real-life data in Hungary

“…Nearly 20% of patients did not fill further prescription after one month both in the donepezil and rivastigmine groups, the ratio being similar as seen in Austria (14%) [ 15 ]. Differently from previous studies [ 11 , 24 , 25 ], where the follow-up of patients was stopped after their drug discontinuations (gaps), we followed discontinuing patients and found that the majority of them returned to ChEi-therapy with a partial or good adherence, which finding is of practical importance in clinical practice.…”

“…In our study, there were fifteen times more donepezil users than rivastigmine. In Poland, donepezil use was three times more common [ 24 ], while in Taiwan and Austria the ratio was even more balanced; donepezil was used only 1.4 and 1.16 times more than rivastigmine, respectively [ 15 , 25 ]. The considerable difference in Hungary may be partially due to the fact that donepezil is available in several generic forms in contrast to rivastigmine, which is marketed as an originator only, resulting in considerably higher monthly therapeutic expenses.…”

Effectiveness of the 10 cm2 Rivastigmine Patch in Taiwanese Patients with Mild-to-Moderate Alzheimer’s Dementia: A 48-Week Real-World Observational Study

“…A decline of 2.3 points per year in MMSE scores has been observed in those who progressed to dementia without treatment [19]. Per the National Health Insurance regulations in Taiwan, patients with AD using reimbursed rivastigmine should switch to another treatment if the MMSE score decreases by more than two points [13]. During the follow-up period, patients treated with the 10 cm 2 rivastigmine patch maintained cognitive performance, and only one patient had to withdraw from the study due to a failure in re-submission for health insurance reimbursement; however, the reason for the failure was not specified.…”

“…The overall persistence and adherence to rivastigmine (oral and the 5 cm 2 patch) versus donepezil in the Taiwanese population was recently reported using the national health dataset [13]. The real-world treatment efficacy of the 10 cm 2 rivastigmine patch in patients with AD has still not been extensively reported.…”

Critical Review of the Determinants of Medication Adherence in Patients With Dementia

“…Chang et al [17] and Hinkin et al [13] suggested that non-adherence may have multiple clinical consequences in addition to cognitive decline. Hinkin [13] also stated that being adherent resulted in a slower decline of multiple cognitive functional and global outcome measures.…”